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Increased breast cancer mortality only in the lower education group: age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983-2012.

ABSTRACT: A steadily increasing pattern of breast cancer mortality has been reported in South Korea since the late 1980s. This paper explored the trends of educational inequalities of female breast cancer mortality between 1983 and 2012 in Korea, and conducted age-period-cohort (APC) analysis by educational level.Age-standardized mortality rates of breast cancer per 100,000 person-years were calculated. Relative index of inequality (RII) for breast cancer mortality was used as an inequality measure. APC analyses were conducted using the Web tool for APC analysis provided by the Division of Cancer Epidemiology and Genetics at the U.S. National Cancer Institute.An increasing trend in breast cancer mortality among Korean women between 1983 and 2012 was due to the increased mortality of the lower education groups (i.e., no formal education or primary education and secondary education groups), not the highest education group. The breast cancer mortality was higher in women with a tertiary education than in women with no education or a primary education during 1983-1992, and the reverse was true in 1993-2012. Consequently, RII was changed from positive to negative associations in the early 2000s. The lower education groups had the increased breast cancer mortality and significant cohort and period effects between 1983 and 2012, whereas the highest group did not.APC analysis by socioeconomic position used in this study could provide an important clue for the causes on breast cancer mortality. The long-term monitoring of socioeconomic patterning in breast cancer risk factors is urgently needed.

SUBMITTER: Bahk J

PROVIDER: S-EPMC5374568 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Increased breast cancer mortality only in the lower education group: age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983-2012.

Bahk Jinwook J Jang Sung-Mi SM Jung-Choi Kyunghee K

International journal for equity in health 20170331 1

<h4>Background</h4>A steadily increasing pattern of breast cancer mortality has been reported in South Korea since the late 1980s. This paper explored the trends of educational inequalities of female breast cancer mortality between 1983 and 2012 in Korea, and conducted age-period-cohort (APC) analysis by educational level.<h4>Methods</h4>Age-standardized mortality rates of breast cancer per 100,000 person-years were calculated. Relative index of inequality (RII) for breast cancer mortality was u ...[more]

PMID: 28359262

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Project description:To evaluate trends in premature cancer mortality in Colombia by educational level in three periods: 1998-2002 with low healthcare insurance coverage, 2003-2007 with rapidly increasing coverage and finally 2008-2012 with almost universal coverage (2008-2012).Colombian population-based, national secondary mortality data.We included all (n=188,091) cancer deaths occurring in the age group 20-64 years between 1998 and 2012, excluding only cases with low levels of quality of registration (n=2902, 1.5%).In this descriptive study, we linked mortality data of ages 20-64 years to census data to obtain age-standardised cancer mortality rates by educational level. Using Poisson regression, we modelled premature mortality by educational level estimating rate ratios (RR), relative index of inequality (RII) and the Slope Index of Inequality (SII).Relative measures showed increased risks of dying among the lower educated compared to the highest educated; this tendency was stronger in women (RRprimary 1.49; RRsecondary 1.22, both p<0.0001) than in men (RRprimary 1.35; RRsecondary 1.11, both p<0.0001). In absolute terms (SII), cancer caused a difference per 100 000 deaths between the highest and lowest educated of 20.5 in males and 28.5 in females. RII was significantly higher among women and the younger age categories. RII decreased between the first and second periods; afterwards (2008-2012), it increased significantly back to their previous levels. Among women, no significant increases or declines in cancer mortality over time were observed in recent periods in the lowest educated group, whereas strong recent declines were observed in those with secondary education or higher.Educational inequalities in cancer mortality in Colombia are increasing in absolute and relative terms, and are concentrated in young age categories. This trend was not curbed by increases in healthcare insurance coverage. Policymakers should focus on improving equal access to prevention, early detection, diagnostic and treatment facilities.

Project description:Incidence and mortality data, stage of disease and treatment information for female breast cancer were obtained for the years 1975-1999 for the former Yorkshire Regional Health Authority area, from the Northern and Yorkshire Cancer Registry and Information Service. Deaths by age group and 3-year calendar period were separated into those occurring among cases diagnosed 0-2 and 3-4 years preceding death (short- and medium-term survivors, respectively), and among longer-term survivors and age-adjusted rates were calculated separately by survival time. The 3-year survival of cases incident in 1991-1999 and in 1982-1990 were compared, adjusting for stage and treatment. Breast cancer mortality in Yorkshire stopped increasing around 1983 and has since consistently declined, primarily among short- and medium-term survivors. The 3-year survival was significantly improved in cases diagnosed in 1991-1999, compared with 1982-1990, in all age groups (hazard ratio (HR)=0.75, 95% c.l. 0.71-0.78). The improvement was least in the 65+ years age group (HR=0.83, 95% c.l. 0.79-0.88), intermediate in the youngest (<50 years) cases (HR=0.71, 95% c.l. 0.63-0.80) and greatest in the age group 50-64 years, offered routine screening after 1988 (HR=0.51, 95% c.l. 0.47-0.57). The benefit for cases diagnosed in the 1990s persisted, but was reduced after adjustment for stage in cases <65 years, while it disappeared in older cases (HR=1.01). Below age 65 years, the use of systemic therapy increased substantially, but did not explain the residual improvements in short-term prognosis. A greater decline in breast cancer mortality in Yorkshire from 1982 to 1984 was observed among short- and medium-term, than in longer-term, survivors. Much of the improvement in survival in cases <65 years could be attributed to a more favourable stage at diagnosis, whereas this accounted for nearly all the improvement in survival among older cases. Systemic therapy had little or no impact on 3-year survival. Continuing declines in mortality can be expected in the current decade, as a result of the long-term effects of both mammography screening and increased use of systemic therapy.

Dataset Information

Increased breast cancer mortality only in the lower education group: age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983-2012.

Publications

Increased breast cancer mortality only in the lower education group: age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983-2012.

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