Relationship of Socio Economic Status, Income, and Education with the Survival Rate of Breast Cancer: A Meta-Analysis

Abstract

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. Conclusion: 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.

Induced Demand in Cancer Diagnosis

“…Improving the social determinants of health, income, and education will result in high overall survival and decreases the probability of overuse (21,22). Patients' expectation (23) which usually increases as the socio-economic status increases, is also an important factor for overusing (18).…”

Survival in breast cancer patients with a delayed DIEP flap breast reconstruction after adjustment for socioeconomic status and comorbidity

“…Disparities in SES, however, do not only affect reconstruction rates but also breast cancer stage [33][34][35] and survival, even in the relatively homogenous Swedish society enjoying a taxfunded health care system and free access to education [4,36,35]. A recent meta-analysis confirmed this on an international level, showing an association between higher SES, income and education and better breast cancer-specific survival [37]. In addition, comorbidity is more prevalent in socioeconomically weaker populations [10].…”

Hubungan intensitas nyeri dengan kualitas hidup pasien kanker payudara yang menjalani kemoterapi di PPLK RSUD Dr. Soetomo

“…Tingkat pendidikan yang dimiliki seseorang berpengaruh terhadap angka kejadian kanker payudara, seseorang dengan tingkat pendidikan yang tinggi seringkali melakukan pemeriksaan secara rutin sehingga apabila terkena kanker payudara dapat diketahui sedini mungkin. 20 Selain itu sebagian besar penderita menjalani kemoterapi yang dilakukan setelah pembedahan, dimana hasil yang didapatkan sejalan dengan penelitian lain bahwa kemoterapi yang dilakukan setelah operasi (adjuvant) dapat mencegah kekambuhan klinis kanker payudara. 9 Rendahnya pengetahuan tentang kanker payudara menyebabkan seseorang tidak melakukan pengobatan pada stadium awal sehingga meningkatkan proporsi terjadinya kanker payudara dengan stadium lanjut.…”

“…5 Pekerjaan sering memengaruhi kualitas hidup pasien kanker payudara, dimana seseorang yang memiliki tingkat pendapatan tinggi seringkali dapat menerima pengobatan yang diinginkan dengan mudah dan cepat. 20 Selain itu kondisi psikologis dan kesehatan fisik juga dapat memengaruhi tinggi atau rendahnya kualitas hidup seseorang. 39 Penelitian ini dapat menunjukan jika rasa nyeri berpengaruh terhadap kualitas hidup seseorang yang berfokus pada pasien yang sedang menjalani kemoterapi dengan menggunakan instrumen SF-36 dan Wong Baker.…”