Centre for Population Health Research, Curtin University, Perth, Australia.
CSIRO Health and Biosecurity, Adelaide, Australia.
Int J Equity Health. 2017 Oct 16;16(1):182. doi: 10.1186/s12939-017-0676-x.
Globally, the provision of equitable outcomes for women with breast cancer is a priority for governments. However, there is growing evidence that a socioeconomic status (SES) gradient exists in outcomes across the breast cancer continuum - namely incidence, diagnosis, treatment, survival and mortality. This systematic review describes this evidence and, because of the importance of place in defining SES, findings are limited to the Australian experience.
An on-line search of PubMed and the Web of Science identified 44 studies published since 1995 which examined the influence of SES along the continuum. The critique of studies included the study design, the types and scales of SES variable measured, and the results in terms of direction and significance of the relationships found. To aid in the interpretation of results, the findings were discussed in the context of a systems dynamic feedback diagram.
We found 67 findings which reported 107 relationships between SES within outcomes along the continuum. Results suggest no differences in the participation in screening by SES. Higher incidence was reported in women with higher SES whereas a negative association was reported between SES and diagnosis. Associations with treatment choice were specific to the treatment choice undertaken. Some evidence was found towards greater survival for women with higher SES, however, the evidence for a SES relationship with mortality was less conclusive.
In a universal health system such as that in Australia, evidence of an SES gradient exists, however, the strength and direction of this relationship varies along the continuum. This is a complex relationship and the heterogeneity in study design, the SES indicator selected and its representative scale further complicates our understanding of its influence. More complex multilevel studies are needed to better understand these relationships, the interactions between predictors and to reduce biases introduced by methodological issues.
在全球范围内，为乳腺癌女性提供公平的结果是政府的优先事项。然而，越来越多的证据表明，在乳腺癌连续体的各个方面，即发病率、诊断、治疗、生存和死亡率，都存在社会经济地位（SES）梯度。本系统综述描述了这方面的证据，由于地理位置在定义 SES 方面的重要性，研究结果仅限于澳大利亚的经验。
在 PubMed 和 Web of Science 上进行在线搜索，确定了自 1995 年以来发表的 44 项研究，这些研究检查了 SES 沿连续体的影响。对研究的评价包括研究设计、SES 变量测量的类型和规模，以及研究结果在关系方向和显著性方面的情况。为了帮助解释结果，研究结果在系统动态反馈图的背景下进行了讨论。
我们发现了 67 项研究结果，其中报告了 107 项 SES 与连续体中各结果之间的关系。结果表明，SES 与筛查参与率之间没有差异。SES 较高的女性发病率较高，而 SES 与诊断之间则呈负相关。SES 与治疗选择之间的关系取决于所选择的治疗方式。有一些证据表明 SES 较高的女性生存情况更好，但是 SES 与死亡率之间的关系证据则不太确定。
在澳大利亚这样的全民医疗体系中，存在 SES 梯度的证据，然而，这种关系的强度和方向沿连续体而异。这是一种复杂的关系，研究设计、SES 指标选择及其代表性尺度的异质性进一步增加了我们对其影响的理解的复杂性。需要更复杂的多层次研究来更好地理解这些关系、预测因素之间的相互作用，并减少方法学问题带来的偏差。
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