3 Social inequities in the risk of death for women diagnosed with an invasive breast cancer in the girona province, spain


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Abstract

Background/aimThe residential environment of women diagnosed with breast cancer (BC) has been suggested to be a key modifier of their survival outcomes, with area deprivation and remoteness (i.e. rural/urban) as chief indicators. Here, we aimed to describe the survival of women diagnosed with an invasive BC in the Girona province (Spain) during 2000–2013 based on the characteristics of their residential area.MethodsWe restricted our analysis to incident invasive BC tumours (ICD-10: C50.X) diagnosed in the Girona province (2000–2013). Data on tumour characteristics and vital status of patients were collected from the population-based Girona Cancer Registry. Bilateral tumours, death certificate and autopsy only cases were excluded. The last updated address of the patients was used to spatially assign them to a census area. We updated and improved a previously validated census area level deprivation index for Spain1. For area remoteness, we used the recommended standard of 150 inhab/km2. A multivariate hazard model for relative survival with frailty and spatial adjustment was fitted. The models were fully adjusted for all available clinical and demographic variables, and hazard ratios (HR) were estimatedResultsA total of 4609 women were diagnosed with invasive BC in the Girona province during 2000 and 2013. Women living in areas classified by our deprivation index as being affluent and deprived, showed slightly higher hazards of death (HR=1.12, 95% CI=0.93 to 1.34 and HR=1.08, 95% CI=0,91 to 1,29, respectively) compared to those with an intermediate deprivation level, yet differences were not significant. Nevertheless, women living in urban areas did show a slightly significant decreased risk of death compared to women living in rural areas (HR=0.84, 95% CI: 0.71 to 0.99).ConclusionThis is the first study to assess the effect of census area deprivation and remoteness on BC survival in the Girona province, and one of a few in Spain. Our results suggest there is no significant inequity by census-area deprivation. However, there exists a slightly poorer survival for women living in rural areas. This can be used to support regulatory approaches to tackle social inequities.

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