Eaker Sonja, Halmin Märit, Bellocco Rino, Bergkvist Leif, Ahlgren Johan, Holmberg Lars, Lambe Mats
Department of Surgery, Uppsala University, Uppsala, Sweden.
Int J Cancer. 2009 Jan 1;124(1):180-7. doi: 10.1002/ijc.23875.
Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20-79 years at diagnosis with primary breast cancer identified in a Swedish population-based clinical register. Information on socioeconomic standing was obtained from a social database. The 5-year cause-specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53-0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours <or=20 mm (68 vs. 64%), were treated at a main hospital (75 vs. 68%) and had received radiation treatment (80 vs. 67%) or chemotherapy (31 vs. 18%). However, these proportional differences could not explain the observed social gradient in survival. To minimize social differences in breast cancer survival, further research should address not only factors leading to inequities in management but also focus on patient factors such as health awareness, comorbidity burden and compliance to adjuvant treatment.
流行病学研究表明，与高社会经济群体相比，低社会经济群体的癌症生存率更低。我们调查了这些差异是否与肿瘤特征和治疗方面的差异有关。这项队列研究基于瑞典一个基于人群的临床登记系统中确诊的9908名年龄在20 - 79岁的原发性乳腺癌女性。社会经济地位信息来自一个社会数据库。通过Cox比例风险模型估计5年特定病因生存率（CSS）和死亡风险比（HR），以评估社会经济群体之间的生存差异，同时调整诊断强度、肿瘤特征和治疗因素。在对年龄、诊断年份和分期进行调整后，高学历女性死于乳腺癌的风险比低学历女性低35%（HR = 0.65，95% CI 0.53 - 0.80）。与高学历女性相比，低学历女性中接受增殖情况检查（84%对76%）或激素受体状态检查（89%对81%）的比例更低，肿瘤≤20 mm的比例更低（68%对64%），在主要医院接受治疗的比例更低（75%对68%），接受放射治疗的比例更低（80%对67%）或化疗的比例更低（31%对18%）。然而，这些比例差异并不能解释观察到的生存方面的社会梯度。为了尽量减少乳腺癌生存方面的社会差异，进一步的研究不仅应关注导致治疗不平等的因素，还应关注患者因素，如健康意识、合并症负担和辅助治疗的依从性。
