Cargando…

Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study

We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were c...

Descripción completa

Detalles Bibliográficos
Autores principales: Walsh, Paul M., Byrne, Julianne, Kelly, Maria, McDevitt, Joe, Comber, Harry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221110/
https://www.ncbi.nlm.nih.gov/pubmed/25372837
http://dx.doi.org/10.1371/journal.pone.0111729
_version_ 1782342849243643904
author Walsh, Paul M.
Byrne, Julianne
Kelly, Maria
McDevitt, Joe
Comber, Harry
author_facet Walsh, Paul M.
Byrne, Julianne
Kelly, Maria
McDevitt, Joe
Comber, Harry
author_sort Walsh, Paul M.
collection PubMed
description We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999–2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21–1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97–1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994–1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.
format Online
Article
Text
id pubmed-4221110
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-42211102014-11-12 Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study Walsh, Paul M. Byrne, Julianne Kelly, Maria McDevitt, Joe Comber, Harry PLoS One Research Article We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999–2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21–1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97–1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994–1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved. Public Library of Science 2014-11-05 /pmc/articles/PMC4221110/ /pubmed/25372837 http://dx.doi.org/10.1371/journal.pone.0111729 Text en © 2014 Walsh et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Walsh, Paul M.
Byrne, Julianne
Kelly, Maria
McDevitt, Joe
Comber, Harry
Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study
title Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study
title_full Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study
title_fullStr Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study
title_full_unstemmed Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study
title_short Socioeconomic Disparity in Survival after Breast Cancer in Ireland: Observational Study
title_sort socioeconomic disparity in survival after breast cancer in ireland: observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221110/
https://www.ncbi.nlm.nih.gov/pubmed/25372837
http://dx.doi.org/10.1371/journal.pone.0111729
work_keys_str_mv AT walshpaulm socioeconomicdisparityinsurvivalafterbreastcancerinirelandobservationalstudy
AT byrnejulianne socioeconomicdisparityinsurvivalafterbreastcancerinirelandobservationalstudy
AT kellymaria socioeconomicdisparityinsurvivalafterbreastcancerinirelandobservationalstudy
AT mcdevittjoe socioeconomicdisparityinsurvivalafterbreastcancerinirelandobservationalstudy
AT comberharry socioeconomicdisparityinsurvivalafterbreastcancerinirelandobservationalstudy