Young H. Breast Cancer Survival in England and Wales: the Influence of Socio-Economic Status, Social Support and Parity. Report submitted in partial fulfillment of the requirements of the Master of Science degree in Medical Demography, London School of Hygiene & Tropical Medicine, University of London. 2002.
Objective: To examine the influence of socio-economic status, two indicators of social support (marital status and household composition) and parity on breast cancer survival for women in England and Wales.
Data: Office for National Statistics (ONS) Longitudinal Study members: 2949 women aged 45 and over, diagnosed with primary malignant breast cancer between 4th April 1981 and end 1997.
Main outcome measure: Crude, cause specific and relative survival percentages at 1, 5 and 10 years after diagnosis and relative rate ratios of mortality calculated using Poisson regression with a user defined link function.
Results: Survival estimates of the cohort as a whole produced very similar results to national cancer registry data estimates. Lower socio-economic status was associated with poorer breast cancer survival, using area based and individual indicators of deprivation. Using the individual indicator of deprivation, private renters with no car had the poorest survival. Differences between marital status groups were only apparent after stratification by age group. Widows and single women over age 75 had poorer breast cancer survival than married women, but widows under 75 were found to have better survival than married women. Differences in survival by household composition were accounted for by marital status, except for women in communal establishments who had very high mortality rates. Survival differences by parity were only observed for women aged 45-59 who had poorer survival if parous and women living in private rental accommodation who had poorer survival if nulliparous.
Conclusions: This study found clear breast cancer survival differentials in England and Wales by marital status and socio-economic status. Survival was worse for single and widowed women than married women but only over age 75, indicating that future research must take this age differential into account. Differences in household composition were mainly accounted for by marital status, indicating that the latter is a more sensitive indicator of social support for elderly women. For younger women, marital status differences in mortality were less marked, suggesting that other support sources may be more important. The parity results should be interpreted with caution due to small sample size and large numbers of missing cases; future research would be needed to confirm these findings.