Article Text
Abstract
Objectives Socioeconomic inequalities in survival after breast cancer persist worldwide. We aim to determine whether adult offspring's socioeconomic resources contribute to inequalities in mothers' survival after breast cancer.
Methods 14 231 women, aged 65–79 years, with a child aged ≥30 years and a first primary diagnosis of breast cancer in the National Cancer Register between 2001 and 2010 were followed until death, 10 years after diagnosis, or end of study (December 2015). Relative survival proportions and excess mortality within 10 years of diagnosis by strata of offspring's education level and disposable income were estimated using flexible parametric models accounting for measures of mothers' socioeconomic position and expected mortality in the general population.
Results 4292 women died during 102 236 person-years of follow-up. Crude 10-year relative survival proportions for mothers of children with >14, 12–14 and <12 years of education were 0.89 (0.87 to 0.91), 0.87 (0.85 to 0.89) and 0.79 (0.76 to 0.81), respectively. Compared with mothers of children with >14 years of education, mothers of children with <12 or 12–14 years of education had substantially higher excess mortality (excess HR 1.69 (1.38 to 2.07) and 1.22 (1.00 to 1.48), respectively). Higher mortality did not differ between tertiles of offspring's disposable income.
Conclusions Adult offspring's education level may contribute to inequalities in mothers' survival after breast cancer. Clinicians should be aware of the educational context beyond the individual and women with less educated offsprings may require extra support. This should be considered in future research, policy frameworks and interventions aimed at reducing survival inequalities.
- PUBLIC HEALTH
- SOCIAL MEDICINE
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Footnotes
Contributors RL and GRW were responsible for the conception of the study. All authors contributed to the study design. MF was responsible for acquiring the data. MT conducted data management and some statistical analyses. HLB carried out the statistical analyses and drafted the manuscript. All authors contributed to the interpretation of the results and contributed to critically revising the manuscript for important intellectual content and approved the final version for submission. RL was responsible for study supervision and is the guarantor for the study. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding HLB is a COFAS Marie Curie Fellow with funding from the Swedish Research Council for Health, Working Life and Welfare (FORTE) (grant registration number 2015-01228). This work was also supported by Karolinska Institutet. All authors are independent of the funders.
Competing interests None declared.
Ethics approval Ethical approval for the study was granted by the Regional Ethical Review Board, Stockholm, Sweden (2011/634-31/4). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Researchers can, after ethical approval, apply for the data from Statistics Sweden and the Swedish National Board of Health and Welfare.