Stage of Diagnosis of Breast Cancer and Socioeconomic Status in a Universal Healthcare System: A Population-Based Study in Emilia-Romagna, Italy.

摘要

Research has shown that lower socioeconomic status (SES) is associated with later stage of diagnosis of breast cancer in the United States healthcare system, where access to services may be an issue. However, limited data exists as to whether this effect is present in a universal healthcare system, without financial barriers to services. We sought to determine the association between stage of diagnosis of breast cancer and SES using data from Emilia-Romagna, a large region in northern Italy. We identified a population of women with incident breast cancer from 2002-2003 regional cancer registries, including information on cancer stage based on the AJCC’S TNM classification. Women with Stage 0 cancers, lymphoma/sarcoma, and tumors identified in the preceding 2 years from hospital discharge data were excluded from this study, yielding a sample of 6,545. For 3,992 (61%) of these women, information on SES, age, marital status, and an index of deprivation were retrieved. Women whose cancer was not staged (n=514) were removed from the final analysis (n=3,478). We computed descriptive statistics for all variables of interest and performed multivariable logistic regressions to evaluate the association between late stage (III/IV) cancer and SES. Women that were aged 70 years and over, single, and widowed were found to be more likely to have Stage III/IV cancer. Regarding SES factors, women with an index of deprivation score of two or more and women who came from families with 5 or more members showed an association with late stage cancer. The results suggest that a socioeconomic gradient related to stage of diagnosis of breast cancer still exists even in healthcare systems with no barriers at the point of use. However, the absence of statistical significance related to the effect of stage of breast cancer at diagnosis with educational level and occupation type may indicate a lesser effect than in competitive systems.