KMID : 0371020100430040330
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Journal of Preventive Medicine and Public Health 2010 Volume.43 No. 4 p.330 ~ p.340
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Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study
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Park Mi-Jin
Chung Woo-Jin Lee Sun-Mi Park Jong-Hyock Chang Hoo-Sun
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Abstract
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Objectives: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea.
Methods: 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.
Results: 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.
Conclusions: 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.
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KEYWORD
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Breast cancer, Cox proportional hazards models, Radical mastectomy, Socioeconomic status, Mortality
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