title: Adult children's socioeconomic resources and mothers' survival after a breast cancer diagnosis: a Swedish population-based cohort study.
abstract: Socioeconomic inequalities in survival after breast cancer persist worldwide. We aim to determine whether adult offspring's socioeconomic resources contribute to inequalities in mothers' survival after breast cancer.
  
  
  
  14 231 women, aged 65-79 years, with a child aged ≥30 years and a first primary diagnosis of breast cancer in the National Cancer Register between 2001 and 2010 were followed until death, 10 years after diagnosis, or end of study (December 2015). Relative survival proportions and excess mortality within 10 years of diagnosis by strata of offspring's education level and disposable income were estimated using flexible parametric models accounting for measures of mothers' socioeconomic position and expected mortality in the general population.
  
  
  
  4292 women died during 102 236 person-years of follow-up. Crude 10-year relative survival proportions for mothers of children with >14, 12-14 and <12 years of education were 0.89 (0.87 to 0.91), 0.87 (0.85 to 0.89) and 0.79 (0.76 to 0.81), respectively. Compared with mothers of children with >14 years of education, mothers of children with <12 or 12-14 years of education had substantially higher excess mortality (excess HR 1.69 (1.38 to 2.07) and 1.22 (1.00 to 1.48), respectively). Higher mortality did not differ between tertiles of offspring's disposable income.
  
  
  
  Adult offspring's education level may contribute to inequalities in mothers' survival after breast cancer. Clinicians should be aware of the educational context beyond the individual and women with less educated offsprings may require extra support. This should be considered in future research, policy frameworks and interventions aimed at reducing survival inequalities.
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Brooke
authors.affiliation: The National Board of Health and Welfare, Stockholm, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Ringbäck Weitoft
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Talbäck
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Feychting
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rickard
authors.identifier: 0000-0002-0654-4530
authors.initials: R
authors.lastname: Ljung
mesh_terms: D000328:Adult; D032721:Adult Children / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality*; D000073116:Cancer Survivors / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008875:Middle Aged; D009035:Mothers / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
keywords: PUBLIC HEALTH; SOCIAL MEDICINE