title: Socioeconomic inequalities in breast cancer incidence and mortality in Europe-a systematic review and meta-analysis.
abstract: Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous.
  
  
  
  We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated.
  
  
  
  The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17-1.32), a significantly decreased case fatality (SRR 0.72, 0.63-0.81) and a significantly increased mortality (SRR 1.16, 1.10-1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors.
  
  
  
  Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.
authors.affiliation: IHE, The Swedish Institute for Health Economics, Lund, Sweden adam.lundqvist@ihe.se.
authors.forename: Adam
authors.initials: A
authors.lastname: Lundqvist
authors.affiliation: IHE, The Swedish Institute for Health Economics, Lund, Sweden.
authors.forename: Emelie
authors.initials: E
authors.lastname: Andersson
authors.affiliation: IHE, The Swedish Institute for Health Economics, Lund, Sweden.
authors.forename: Ida
authors.initials: I
authors.lastname: Ahlberg
authors.affiliation: Institute of Clinical Sciences, Department of Oncology, Lund University, Lund, Sweden.
authors.forename: Mef
authors.initials: M
authors.lastname: Nilbert
authors.affiliation: IHE, The Swedish Institute for Health Economics, Lund, Sweden.|Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Gerdtham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D002423:Cause of Death / Q000639:trends*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012307:Risk Factors; D012959:Socioeconomic Factors