Relationship of Socio Economic Status, Income, and Education with the Survival Rate of Breast Cancer: A Meta-Analysis
Background: Despite our awareness of the significant effect of Social Determinant of Health (SDoH) such as Socio Economic Status (SES), income and education on breast cancer survival, there was a serious lack of information about the effect of different level of these factors on breast cancer survival. So far, no meta-analysis has been conducted with this aim, but this gap was addressed by this meta-analysis.
Methods: Main electronic databases such as PubMed, Web of Science, and Scopus were investigated up to January 2019. Epidemiological studies focusing on the association between SDoH and breast cancer were singled out. Q-test and I2 statistic were used to study the heterogeneity across studies. Begg's and Egger's tests were applied to explore the likelihood of the publication bias. The results were reported as hazard ratio (HR) with 95% confidence intervals (CI) through a random-effects model.
Results: We identified 7,653 references and included 25 studies involving 1,497,881 participants. The HR estimate of breast cancer survival was 0.82 (0.67, 0.98) among high level of SES, 0.82 (0.70, 0.94) among high level of income and 0.72 (0.66, 0.78) among academic level of education.
Conclusions: The SES, income, and education were associated with breast cancer survival, although the association was not very strong. However, there was a significant association between the levels of these factors and breast cancer survival.
2. Zaorsky NG, Churilla TM, Egleston BL et al (2017). Causes of death among cancer patients. Ann Oncol, 28(2): 400-407.
3. DeSantis C, Siegel R, Bandi P, Jemal A (2011). Breast cancer statistics, 2011. CA Cancer J Clin, 61(6): 408-418.
4. Diaz de la Noval B, Frias Aldeguer L, et al (2018). Increasing survival of metastatic breast cancer through locoregional surgery. Minerva Ginecol, 70(1): 44-52.
5. Guo F, Kuo YF, Shih YCT et al (2018). Trends in breast cancer mortality by stage at diagnosis among young women in the United States. Cancer, 124(17): 3500-3509.
6. Yoshimura A, Ito H, Nishino Y et al (2018). Recent Improvement in the Long-term Survival of Breast Cancer Patients by Age and Stage in Japan. J Epidemiol, 28(10): 420-427.
7. Berry DA, Cronin KA, Plevritis SK, et al (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med, 353(17):1784-92.
8. Link BG, Phelan JC (1996). Understanding sociodemographic differences in health--the role of fundamental social causes. Am J Public Health, 86(4): 471-473.
9. Maia MF, Kliner M, Richardson M, Lengeler C, Moore SJ (2018). Mosquito repellents for malaria prevention. Cochrane Database Syst Rev, 2:CD011595.
10. Kelly MP, Bonnefoy J, Morgan A, Florenzano F (2006). The development of the evidence base about the social determinants of health. Geneva: World Health Organization.
11. Bouchardy C, Verkooijen HM, Fioretta G (2006). Social class is an important and independent prognostic factor of breast cancer mortality. Int J Cancer, 119(5):1145-1151.
12. Brooke HL, Weitoft GR, Talbäck M et al (2017). Adult children's socioeconomic resources and mothers' survival after a breast cancer diagnosis: A Swedish population-based cohort study. BMJ Open, 7(3): e014968.
13. Agarwal S, Ying J, Boucher KM, Agarwal JP (2017). The association between socioeconomic factors and breast cancer-specific survival varies by race. PLoS One, 12(12): e0187018.
14. Hussain SK, Altieri A, Sundquist J, Hemminki K (2008). Influence of education level on breast cancer risk and survival in Sweden between 1990 and 2004. Int J Cancer, 122(1): 165-169.
15. Miki Y, Inoue M, Ikeda A, et al (2014). Neighborhood Deprivation and Risk of Cancer Incidence, Mortality and Survival: Results from a Population-Based Cohort Study in Japan. PLoS One, 9(9): e106729.
16. Ataollahi MR, Sharifi J, Paknahad MR, Paknahad A (2015). Breast cancer and associated factors: a review. J Med Life, 8(Spec Iss 4):6-11.
17. Braveman P, Gottlieb L (2014). The social determinants of health: it's time to consider the causes of the causes. Public Health Rep, 129 Suppl 2:19-31.
18. Wells GA, Shea B, O'Connell D et al (2009). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, Ontario.
19. Higgins JPT, Green S (2008). Cochrane handbook for systematic reviews of interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration.
20. Begg CB, Mazumdar M (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50(4):1088-101.
21. Egger M, Davey SG, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109):629-634.
22. DerSimonian R, Laird N (1986). Meta-analysis in clinical trials. Control Clin Trials, 7(3): 177-188.
23. Arias-Ortiz NE, de Vries E (2018). Health inequities and cancer survival in Manizales, Colombia: a population-based study. Colomb Med (Cali), 49(1): 63-72.
24. Chang CM, Su YC, Lai NS et al (2012). The combined effect of individual and neighborhood socioeconomic status on cancer survival rates. PLoS One, 7(8): e44325.
25. Dalton SO, Ross L, Düring M et al (2007). Influence of socioeconomic factors on survival after breast cancer - A nationwide cohort study of women diagnosed with breast cancer in Denmark 1983-1999. Int J Cancer, 121(11):2524-2531.
26. Davoudi Monfared E, Mohseny M, Amanpour F et al (2017). Relationship of Social Determinants of Health with the Three-year Survival Rate of Breast Cancer. Asian Pac J Cancer Prev, 18(4): 1121-1126.
27. Diniz RW, Guerra MR, Cintra JRD et al (2016). Disease-free survival in patients with non-metastatic breast cancer. Rev Assoc Med Bras, 62(5): 407-413.
28. Du XL, Fang SY, Meyer TE (2008). Impact of treatment and socioeconomic status on racial disparities in survival among older women with breast cancer. Am J Clin Oncol, 31(2):125-132.
29. Eaker S, Halmina M, Bellocco R, et al (2009). Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden). Int J Cancer, 124(1): 180-187.
30. Feller A, Schmidlin K, Bordoni A, et al (2017). Socioeconomic and demographic disparities in breast cancer stage at presentation and survival: A Swiss population-based study. Int J Cancer, 141(8): 1529-1539.
31. Gajalakshmi CK, Shanta V, Swaminathan R et al (1997). A population-based survival study on female breast cancer in Madras, India. Br J Cancer, 75(5): 771-5.
32. Goldberg M, Calderon-Margalit R, Paltiel O et al (2015). Socioeconomic disparities in breast cancer incidence and survival among parous women: findings from a population-based cohort, 1964-2008. BMC Cancer, 15:921.
33. Hastert TA, Beresford SAA, Sheppard L, White E (2015). Disparities in cancer incidence and mortality by area-level socioeconomic status: a multilevel analysis. J Epidemiol Community Health, 69(2):168-176.
34. Lagerlund M, Bellocco R, Karlsson P, Tejler G, Lambe M (2005). Socio-economic factors and breast cancer survival - A population-based cohort study (Sweden). Cancer Causes Control, 16(4): 419-430.
35. Larsen SB, Kroman N, Ibfelt EH et al (2015). Influence of metabolic indicators, smoking, alcohol and socioeconomic position on mortality after breast cancer. Acta Oncol, 54(5):780-788.
36. Rezaianzadeh A, Peacock J, Reidpath D et al (2009). Survival analysis of 1148 women diagnosed with breast cancer in Southern Iran. BMC Cancer, 9: 168.
37. Schrijvers CTM, Coebergh JW, Van Der Heijden LH, Mackenbach JP (1995). Socioeconomic variation in cancer survival in the Southeastern Netherlands, 1980-1989. Cancer, 75(12): 2946-2953.
38. Shariff-Marco S, Yang J, John EM, et al (2015). Intersection of Race/Ethnicity and Socioeconomic Status in Mortality After Breast Cancer. J Community Health, 40(6): 1287-1299.
39. Stavraky KM, Skillings JR, Stitt LW, Gwadry-Sridhar F (1996). The effect of socioeconomic status on the long-term outcome of cancer. J Clin Epidemiol, 49(10):1155-1160.
40. Teng AM, Atkinson J, Disney G et al (2017). Changing socioeconomic inequalities in cancer incidence and mortality: Cohort study with 54 million person-years follow-up 1981-2011. Int J Cancer, 140(6): 1306-1316.
41. Angeles-Llerenas A, Torres-Mejia G, Lazcano-Ponce E, et al (2016). Effect of care-delivery delays on the survival of Mexican women with breast cancer. Salud Publica Mex, 58(2): 237-250.
42. Dabbikeh A, Peng Y, Mackillop WJ et al (2017). Temporal trends in the association between socioeconomic status and cancer survival in Ontario: a population-based retrospective study. CMAJ Open, 5(3):E682-E689.
43. Lan NH, Laohasiriwong W, Stewart JF (2013). Survival probability and prognostic factors for breast cancer patients in Vietnam. Glob Health Action, 6:1-9.
44. Higgins JPT, Green S (2011). Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration.
45. Steenland K, Henley J, Thun M (2002). All-cause and cause-specific death rates by educational status for two million people in two American Cancer Society cohorts, 1959–1996. Am J Epidemiol, 156(1):11-21.
46. Herndon JE, Kornblith AB, Holland JC, Paskett ED (2013). Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials. Psychooncology, 22(2): 315-323.
47. Damiani G, Basso D, Acampora A et al (2015). The impact of level of education on adherence to breast and cervical cancer screening: Evidence from a systematic review and meta-analysis. Prev Med, 81:281-9.
48. Sprague BL, Trentham-Dietz A, Gangnon RE, et al (2011). Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer, 117(7):1542-51.
49. Morley KI, Milne RL, Giles GG et al (2010). Socio-economic status and survival from breast cancer for young, Australian, urban women. Aust N Z J Public Health, 34(2):200-5.
50. Aziz Z, Sana S, Akram M, Saeed A (2004). Socioeconomic status and breast cancer survival in Pakistani women. J Pak Med Assoc, 54(9): 448-53.
51. Yu XQ (2009). Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer, 9:364.
52. Silber JH, Rosenbaum PR, Ross RN, et al (2018). Disparities in Breast Cancer Survival by Socioeconomic Status Despite Medicare and Medicaid Insurance. Milbank Q, 96(4):706-754.