Toggle Main Menu Toggle Search

Open Access padlockePrints

Are socio-economic inequalities in breast cancer survival explained by peri-diagnostic factors?

Lookup NU author(s): Dr Laura WoodsORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021, The Author(s).Background: Patients living in more deprived localities have lower cancer survival in England, but the role of individual health status at diagnosis and the utilisation of primary health care in explaining these differentials has not been widely considered. We set out to evaluate whether pre-existing individual health status at diagnosis and primary care consultation history (peri-diagnostic factors) could explain socio-economic differentials in survival amongst women diagnosed with breast cancer. Methods: We conducted a retrospective cohort study of women aged 15–99 years diagnosed in England using linked routine data. Ecologically-derived measures of income deprivation were combined with individually-linked data from the English National Cancer Registry, Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) databases. Smoking status, alcohol consumption, BMI, comorbidity, and consultation histories were derived for all patients. Time to breast surgery was derived for women diagnosed after 2005. We estimated net survival and modelled the excess hazard ratio of breast cancer death using flexible parametric models. We accounted for missing data using multiple imputation. Results: Net survival was lower amongst more deprived women, with a single unit increase in deprivation quintile inferring a 4.4% (95% CI 1.4–8.8) increase in excess mortality. Peri-diagnostic co-variables varied by deprivation but did not explain the differentials in multivariable analyses. Conclusions: These data show that socio-economic inequalities in survival cannot be explained by consultation history or by pre-existing individual health status, as measured in primary care. Differentials in the effectiveness of treatment, beyond those measuring the inclusion of breast surgery and the timing of surgery, should be considered as part of the wider effort to reduce inequalities in premature mortality.

Publication metadata

Author(s): Woods LM, Rachet B, Morris M, Bhaskaran K, Coleman MP

Publication type: Article

Publication status: Published

Journal: BMC Cancer

Year: 2021

Volume: 21

Issue: 1

Online publication date: 01/05/2021

Acceptance date: 23/03/2021

Date deposited: 19/05/2022

ISSN (electronic): 1471-2407

Publisher: BioMed Central Ltd


DOI: 10.1186/s12885-021-08087-x

PubMed id: 33933034


Altmetrics provided by Altmetric


Funder referenceFunder name