title: Socioeconomic disparities in breast cancer incidence and survival among parous women: findings from a population-based cohort, 1964-2008.
abstract: BACKGROUND
  Socioeconomic position (SEP) has been associated with breast cancer incidence and survival. We examined the associations between two socioeconomic indicators and long-term breast cancer incidence and survival in a population-based cohort of parous women.
  
  
  METHODS
  Residents of Jerusalem who gave birth between 1964-1976 (n = 40,586) were linked to the Israel Cancer Registry and Israel Population Registry to determine breast cancer incidence and vital status through mid-2008. SEP was assessed by husband's occupation and the woman's education. We used log ranks tests to compare incidence and survival curves by SEP, and Cox proportional hazard models to adjust for demographic, reproductive and diagnostic factors and assess effect modification by ethnic origin.
  
  
  RESULTS
  In multivariable models, women of high SEP had a greater risk of breast cancer compared to women of low SEP (Occupation: HR 1.18, 95 % CI 1.03-1.35; Education: HR 1.39, 95 % CI 1.21-1.60) and women of low SEP had a greater risk of mortality after a breast cancer diagnosis (Occupation: HR 1.33, 95 % CI 1.04-1.70; Education: HR 1.37, 95 % CI 1.06-1.76). The association between education and survival was modified by ethnic origin, with a gradient effect observed only among women of European origin. Women of Asian, North African and Israeli origin showed no such trend.
  
  
  CONCLUSIONS
  SEP was associated with long-term breast cancer incidence and survival among Israeli Jews. Education had a stronger effect on breast cancer outcomes than occupation, suggesting that a behavioral mechanism may underlie disparities. More research is needed to explain the difference in the effect of education on survival among European women compared to women of other ethnicities.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th St., 7th floor, New York, NY, 10032, USA. mg3431@columbia.edu.|Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. mg3431@columbia.edu.
authors.forename: Mandy
authors.initials: M
authors.lastname: Goldberg
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. ronitcm@gmail.com.
authors.forename: Ronit
authors.initials: R
authors.lastname: Calderon-Margalit
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. orap@hadassah.org.il.|Department of Hematology, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. orap@hadassah.org.il.
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. wiessam@gmail.com.
authors.forename: Wiessam
authors.initials: W
authors.lastname: Abu Ahmad
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. yechielf@ekmd.huji.ac.il.
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Friedlander
authors.affiliation: Department of Psychiatry, New York University School of Medicine, New York, NY, USA. susan.harlap@gmail.com.|Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA. susan.harlap@gmail.com.|Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA. susan.harlap@gmail.com.
authors.forename: Susan
authors.initials: S
authors.lastname: Harlap
authors.affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah Medical Organization, Jerusalem, Israel. orlyma@ekmd.huji.ac.il.
authors.forename: Orly
authors.initials: O
authors.lastname: Manor
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D012042:Registries; D012959:Socioeconomic Factors; D016019:Survival Analysis; D044465:White People / Q000208:ethnology