Socioeconomic inequalities in metastasis, recurrence, stage and grade of breast cancer: a hospital-based retrospective cohort study

J Prev Med Hyg. 2019 Sep 30;60(3):E262-E269. doi: 10.15167/2421-4248/jpmh2019.60.3.1162. eCollection 2019 Sep.

Abstract

Introduction: This study aims to estimate the Socio-Economic Status (SES) inequality on the metastasis, recurrence, stage and grade in Breast Cancer (BC).

Methods: This retrospective cohort study conducted on 411 BC patients in Arak, Iran. Asset-based questionnaire used to estimate the household SES. For calculate of SES inequality was used from Concentration Index (C). Moreover for investigate the association between recurrence and metastasis with other variables were used from multilevel logistic regression and analysis of variance were used to investigate the relationship between SES and other variables. The data were analyzed with Stata (v.13) software.

Results: Results of analysis of variance showed statistical significant relationship between SES with, insurance, surgery, grade, stage, recurrence and metastasis (p-value < 0.05). Moreover the Odds Ratio (OR) were significant of recurrence with age, academic level of education, supplementary insurance history of BC in first-degree relatives, stage and grade, also, metastasis with age of > 80 years, insurance, supplementary insurance, history of BC in first-degree relatives, chemotherapy, radiotherapy, stage and grade four. The total C index obtained 0.015 (0.002, 0.026), 0.011 (0.003, 0.031), - 0.014 (- 0.034, - 0.001) and - 0.042 (- 0.061, - 0.002) for metastasis, recurrence, stage and grade of BC respectively.

Conclusions: Our results showed evidence of inequality in the metastasis, recurrence, stage and grade in BC patients.

Keywords: Breast Cancer; Concentration Index; Inequality; Socio-Economic Status.

MeSH terms

  • Adult
  • Age Factors
  • Breast Neoplasms / pathology
  • Breast Neoplasms / therapy*
  • Cohort Studies
  • Educational Status
  • Female
  • Health Status Disparities*
  • Humans
  • Insurance, Health / statistics & numerical data
  • Iran
  • Logistic Models
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Staging
  • Odds Ratio
  • Principal Component Analysis
  • Retrospective Studies
  • Social Class*
  • Socioeconomic Factors