Park Mi Jin, Chung Woojin, Lee Sunmi, Park Jong Hyock, Chang Hoo Sun
Graduate School of Public Health, Yonsei University, Korea.
J Prev Med Public Health. 2010 Jul;43(4):330-40. doi: 10.3961/jpmph.2010.43.4.330.
This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea.
This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership.
Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group.
The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.
本研究旨在评估并解释韩国乳腺癌手术后全因死亡率的社会经济不平等现象。
这项基于人群的研究纳入了2002年1月至2003年6月期间接受乳腺癌根治性乳房切除术的所有8868名女性。对死亡率的随访从2002年1月持续至2006年6月。根据国民健康保险贡献率所定义的社会经济地位，将患者分为4个社会经济阶层。使用Cox比例风险模型评估社会经济地位与乳腺癌手术后全因死亡率之间的关系，并对年龄、查尔森指数评分、急诊住院情况、医院类型和医院所有权进行了调整。
在控制了所有可识别的混杂变量后，社会经济地位最低的组与社会经济地位最高的组相比，风险比显著更高，为2.09（95%置信区间=1.50 - 2.91）。对于根治性乳房切除术后的全因死亡率，所有其他收入组的3年死亡率均显著高于最高收入组。
乳腺癌患者的社会经济地位应被视为影响根治性乳房切除术后全因死亡率的一个独立预后因素，这可能是由于诊断延迟、获得治疗的机会有限或治疗不足导致死亡率升高。本研究可能为加强对社会经济地位较低女性乳腺癌的监测和治疗提供切实支持。
