Abstract
Breast cancer is one of the most common causes of cancer mortality in Iran. Social determinants of health are among the key factors affecting the pathogenesis of diseases. This cross-sectional study aimed to determine the social determinants of breast cancer survival time with parametric and semi-parametric regression models. It was conducted on male and female patients diagnosed with breast cancer presenting to the Cancer Research Center of Shohada-E-Tajrish Hospital from 2006 to 2010. The Cox proportional hazard model and parametric models including the Weibull, log normal and log-logistic models were applied to determine the social determinants of survival time of breast cancer patients. The Akaike information criterion (AIC) was used to assess the best fit. Statistical analysis was performed with STATA (version 11) software. This study was performed on 797 breast cancer patients, aged 25-93 years with a mean age of 54.7 (±11.9) years. In both semi-parametric and parametric models, the three-year survival was related to level of education and municipal district of residence (P<0.05). The AIC suggested that log normal distribution was the best fit for the three-year survival time of breast cancer patients. Social determinants of health such as level of education and municipal district of residence affect the survival of breast cancer cases. Future studies must focus on the effect of childhood social class on the survival times of cancers, which have hitherto only been paid limited attention.
Highlights
Breast cancer is the most common type of cancer diagnosed in women and is the main cause of cancer-related death in females
Strong evidence suggests that such variability in diseases like breast cancer is related to social determinants of health (Adler and Stewart 2010)
We evaluated social determinants of health in breast cancer patients by focusing on personal aspects, socioeconomic status, occupational factors, high-risk behaviors, access to health care services, childhood conditions and family history
Summary
Breast cancer is the most common type of cancer diagnosed in women and is the main cause of cancer-related death in females. A reduction in morbidity and mortality related to breast cancer has been reported in the north, south and west of Europe (Autier et al, 2011) while the trend of breast cancer-related morbidity and mortality is increasing in Asia, Japan, Korea and China (Katanoda and Yako-Suketomo 2010). Such variability may be related to several factors, and many studies have focused on differences among the communities possibly affecting the prevalence and morbidity and mortality of diseases. Social determinants of health are factors that affect the interaction of people with the health care system (Dryden et al, 2012)
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