Andersen Ingelise, Kolodziejczyk Christophe, Thielen Karsten, Heinesen Eskil, Diderichsen Finn
Section of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014, Copenhagen K, Denmark.
KORA, Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150, Copenhagen K, Denmark.
BMC Public Health. 2015 Jan 31;15:50. doi: 10.1186/s12889-015-1387-0.
The purpose of this study was to investigate whether there is an association between stage of incident breast cancer (BC) and personal income three years after diagnosis. The analysis further considered whether the association differed among educational groups.
The study was based on information from Danish nationwide registers. A total of 7,372 women aged 30-60 years diagnosed with BC, 48% with metastasis, were compared to 213,276 controls. Generalised linear models were used to estimate the effect of a cancer diagnosis on personal gross income three years after diagnosis, stratified by education and stage of cancer. The models were adjusted for income two years prior to cancer diagnosis and demographic, geographic and co-morbidity covariates.
Adjusting for income two years prior to cancer diagnosis and other baseline covariates (see above), cancer had a minor effect on personal income three years after diagnosis. The effect of metastatic BC was a statistically significant reduction in income three years after diagnosis of -3.4% (95% CI -4.8;-2.0), -2.8% (95% CI -4.3;-1.3) and -4.1 (95% CI -5.9;-2.3) among further, vocational and low educated women, respectively. The corresponding estimates for the effect of localised BC were -2.5% (95% CI -3.8; -1.2), -1.6% (95% CI -3.0; -0.2) and -1.7% (95% CI -3.7; 0.3); the latter estimate (for the low-educated) was not statistically different from zero. We found no statistically significant educational gradient in the effect of cancer stage on income.
In a Danish context, the very small negative effect of BC on personal income may be explained by different types of compensation in low- and high-income groups. The public income transfers are equal for all income groups and cover a relatively high compensation among low-income groups. However, high-income groups additionally receive pay-outs from private pension and insurance schemes, which typically provide higher coverage for high-income workers.
本研究旨在调查初发乳腺癌（BC）的分期与诊断三年后的个人收入之间是否存在关联。该分析进一步考虑了这种关联在不同教育程度组之间是否存在差异。
本研究基于丹麦全国登记册中的信息。将总共7372名年龄在30 - 60岁之间、48%有转移的乳腺癌确诊女性与213276名对照进行比较。使用广义线性模型来估计癌症诊断对诊断三年后个人总收入的影响，并按教育程度和癌症分期进行分层。模型针对癌症诊断前两年的收入以及人口统计学、地理和合并症协变量进行了调整。
在对癌症诊断前两年的收入和其他基线协变量进行调整后（见上文），癌症对诊断三年后的个人收入影响较小。转移性乳腺癌的影响是，在高等教育、职业教育和低教育程度女性中，诊断三年后的收入分别有统计学显著下降，降幅分别为 - 3.4%（95%置信区间 - 4.8；- 2.0）、- 2.8%（95%置信区间 - 4.3；- 1.3）和 - 4.1%（95%置信区间 - 5.9；- 2.3）。局限性乳腺癌影响的相应估计值分别为 - 2.5%（95%置信区间 - 3.8；- 1.2）、- 1.6%（95%置信区间 - 3.0；- 0.2）和 - 1.7%（95%置信区间 - 3.7；0.3）；后者（针对低教育程度者）的估计值与零无统计学差异。我们发现癌症分期对收入的影响不存在统计学显著的教育梯度。
在丹麦的背景下，乳腺癌对个人收入的极小负面影响可能是由于低收入和高收入群体的不同补偿方式。公共收入转移对所有收入群体都是平等的，并且在低收入群体中提供了相对较高的补偿。然而，高收入群体还额外从私人养老金和保险计划中获得赔付，这些通常为高收入工作者提供更高的保障。
