Joe Feinglass1, Nick Rydzewski2, Anthony Yang3. 1. Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: j-feinglass@northwestern.edu. 2. Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 3. Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
PURPOSE: To analyze the association between socioeconomic status (SES) and all-cause mortality among women diagnosed with breast cancer before and after controlling for insurance status, race and ethnicity, stage, treatment modalities, and other demographic and hospital characteristics. METHODS: Data analyzed included follow-up through 2011 for 582,396 patients diagnosed between 1998 and 2006 with ductal carcinoma in situ or invasive (stage I-IV) breast cancer from the National Cancer Data Base. SES was measured by grouping patients into six income and education-level ZIP code categories. Hierarchical Cox regression models were used to analyze SES survival differences. RESULTS: Five- and 10-year survival probabilities for the highest SES group were 87.8% and 71.5%, versus 79.5% and 61.5% for the lowest SES group. Controlling for all covariates reduced the highest-to-lowest SES hazard ratio from 1.69 (95% confidence interval: 1.64-1.74) to 1.27 (95% confidence interval: 1.24-1.31). Results were virtually identical in models that included comorbidity and invasive cancer patients only. CONCLUSIONS: Differences in insurance status, race, and stage at diagnosis are important components of SES disparities and explain about two-thirds of the initial SES survival disparity. The residual SES effect likely mirrors underlying social determinants of health for all American women.
PURPOSE: To analyze the association between socioeconomic status (SES) and all-cause mortality among women diagnosed with breast cancer before and after controlling for insurance status, race and ethnicity, stage, treatment modalities, and other demographic and hospital characteristics. METHODS: Data analyzed included follow-up through 2011 for 582,396 patients diagnosed between 1998 and 2006 with ductal carcinoma in situ or invasive (stage I-IV) breast cancer from the National Cancer Data Base. SES was measured by grouping patients into six income and education-level ZIP code categories. Hierarchical Cox regression models were used to analyze SES survival differences. RESULTS: Five- and 10-year survival probabilities for the highest SES group were 87.8% and 71.5%, versus 79.5% and 61.5% for the lowest SES group. Controlling for all covariates reduced the highest-to-lowest SES hazard ratio from 1.69 (95% confidence interval: 1.64-1.74) to 1.27 (95% confidence interval: 1.24-1.31). Results were virtually identical in models that included comorbidity and invasive cancerpatients only. CONCLUSIONS: Differences in insurance status, race, and stage at diagnosis are important components of SES disparities and explain about two-thirds of the initial SES survival disparity. The residual SES effect likely mirrors underlying social determinants of health for all American women.
Authors: Adam B Weiner; Richard S Matulewicz; Jeffrey J Tosoian; Joseph M Feinglass; Edward M Schaeffer Journal: Urol Oncol Date: 2017-11-15 Impact factor: 3.498
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Authors: Kirsten M M Beyer; Yuhong Zhou; Purushottam W Laud; Emily L McGinley; Tina W F Yen; Courtney Jankowski; Nicole Rademacher; Sima Namin; Jamila Kwarteng; Sara Beltrán Ponce; Ann B Nattinger Journal: J Clin Oncol Date: 2021-06-15 Impact factor: 50.717
Authors: Ruth Link-Gelles; Daniel Westreich; Allison E Aiello; Nong Shang; David J Weber; Corinne Holtzman; Karen Scherzinger; Arthur Reingold; William Schaffner; Lee H Harrison; Jennifer B Rosen; Susan Petit; Monica Farley; Ann Thomas; Jeffrey Eason; Christine Wigen; Meghan Barnes; Ola Thomas; Shelley Zansky; Bernard Beall; Cynthia G Whitney; Matthew R Moore Journal: SSM Popul Health Date: 2016-12