LVMT, Université Gustave Eiffel, Ecole des Ponts, Champs-sur-Marne, France.
Université Paris Nanterre, UMR 7533 LADYSS, Nanterre, France.
PLoS One. 2022 Jul 19;17(7):e0271319. doi: 10.1371/journal.pone.0271319. eCollection 2022.
Socio-economic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socio-economic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models.
在欧洲国家和美国，乳腺癌死亡率的社会经济和地理不平等现象已经得到了广泛描述。为了研究地理可达性和社会经济特征对乳腺癌结局的综合影响，进行了系统评价，探讨了以下因素之间的关系：（i）医疗保健设施（肿瘤服务、乳房 X 光筛查）的地理可达性，定义为旅行时间和/或旅行距离；（ii）乳腺癌相关结局（乳房 X 光筛查、诊断时癌症分期、治疗类型和死亡率）；（iii）个体和居住环境层面的社会经济地位（SES）。共有 25 项研究（测试了 29 种关系）纳入本系统评价。主要结果有四个：地理可达性与乳腺癌相关结局之间的关系的统计学意义具有异质性：15 项被确定为显著，14 项为非显著。与地理可达性较差的女性相比，地理可达性较好的女性接受乳房切除术的比例明显较低（n = 4/6）。与癌症分期的关系更为平衡（n = 8/17），与癌症筛查率的关系未观察到（n = 1/4）。地理可达性的测量方式（距离、时间或地理容量）似乎对结果没有任何影响。例如，比较地理可达性的两种不同度量（旅行距离和旅行时间）的研究得出了相似的结果。SES 特征与乳腺癌相关结局的关系在多个变量中具有统计学意义：个体层面上的年龄和健康保险状况；环境层面上的贫困率和剥夺指数。在纳入评价的 25 篇论文中，绝大多数（n = 24）检验了地理可达性的独立影响。只有一项研究通过建立分层模型，探讨了乳腺癌设施的地理可达性和 SES 特征的综合影响。
