{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:31:12Z","timestamp":1777519872958,"version":"3.51.4"},"reference-count":49,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: We aimed to analyze the relationship between the survival of patients with breast cancer and health inequalities. Methods: A retrospective cohort study of women with stage III breast cancer according to public healthcare was conducted. Groups were stratified according to the course of treatment and the presence of chronic disease other than cancer. Survival functions were estimated by using the Kaplan\u2013Meier estimator, while the Cox proportional hazards model was employed for prognostic assessment. Results: The study was performed on 964 breast cancer patients. One hundred and seventy-six patients (18.23%) died during the follow-up period and 788 (81.77%) were alive at the end of the follow-up period. Education, marital status, personal history of prior biopsies, and socioeconomic status (SES) were found to be linked with survival. However, only SES exceeded the baseline risk of mortality when the treatment cycle was interrupted (full treatment: unadjusted 4.683, p = 0.001; adjusted 4.888 p = 0.001, partial treatment: unadjusted 1.973, p = 0.012; adjusted 4.185, p = 0.001). The same effect was observed when stratifying by the presence of chronic disease other than cancer (with chronic disease adjusted HR = 4.948, p = 0.001; unadjusted HR = 3.303, p = 0.001; without chronic disease adjusted HR = 4.850, p = 0.001; unadjusted HR = 5.121, p = 0.001). Conclusion: Since lower SES was linked with a worse prognosis, strategies to promote preventive medicine, particularly breast cancer screening programs and prompt diagnosis, are needed.<\/jats:p>","DOI":"10.3390\/ijerph20075329","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T04:45:35Z","timestamp":1680151535000},"page":"5329","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Relationship between Health Inequalities and Breast Cancer Survival in Mexican Women"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4569-3643","authenticated-orcid":false,"given":"Isabel","family":"Sollozo-Dupont","sequence":"first","affiliation":[{"name":"Department of Radiology, Instituto Nacional de Cancerolog\u00eda M\u00e9xico, Mexico City 14080, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor Jes\u00fas","family":"Lara-Ameca","sequence":"additional","affiliation":[{"name":"Department of Radiology, Instituto Nacional de Cancerolog\u00eda M\u00e9xico, Mexico City 14080, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dulce","family":"Cruz-Castillo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Instituto Nacional de Cancerolog\u00eda M\u00e9xico, Mexico City 14080, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yolanda","family":"Villase\u00f1or-Navarro","sequence":"additional","affiliation":[{"name":"Department of Radiology, Instituto Nacional de Cancerolog\u00eda M\u00e9xico, Mexico City 14080, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"20211033","DOI":"10.1259\/bjr.20211033","article-title":"Understanding breast cancer as a global health concern","volume":"95","author":"Wilkinson","year":"2022","journal-title":"Br. J. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1200\/JGO.2016.007476","article-title":"Cancer Trends in Mexico: Essential Data for the Creation and Follow-Up of Public Policies","volume":"6","author":"Mohar","year":"2017","journal-title":"J. Glob. Oncol."},{"key":"ref_3","unstructured":"International Agency for Reserch on Cancer (2022, December 03). Mexico Source: GLOBOCAN 2020. The Global Cancer Observatory. Available online: https:\/\/gco.iarc.fr\/today\/data\/factsheets\/populations\/484-mexico-fact-sheets.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.jacr.2017.06.001","article-title":"Breast cancer screening for average-risk women: Recommendations from the ACR commission on breast imaging","volume":"14","author":"Monticciolo","year":"2017","journal-title":"J. Am. Coll. Radiol."},{"key":"ref_5","unstructured":"Sullivan, T., Sullivan, R., and Ginsburg, M. (2015). Disease Control Priorities, The International Bank for Reconstruction and Development\/The World Bank. [3rd ed.]."},{"key":"ref_6","first-page":"54501","article-title":"Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low-income and middle-income countries: A systematic review","volume":"12","author":"Nnaji","year":"2022","journal-title":"BMJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/s43856-022-00097-5","article-title":"Global disparities in access to cancer care","volume":"2","author":"Gupta","year":"2022","journal-title":"Commun. Med."},{"key":"ref_8","unstructured":"World Health Organization (2022, December 03). Health Inequities and Their Causes. World Health Organization. Available online: https:\/\/www.who.int\/news-room\/facts-in-pictures\/detail\/health-inequities-and-their-causes."},{"key":"ref_9","first-page":"349","article-title":"Lifetime socioeconomic status and late-life health trajectories: Longitudinal results from the Mexican Health and Aging Study","volume":"73","author":"Torres","year":"2018","journal-title":"J. Gerontol. Ser. B"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s12403-019-00310-2","article-title":"Environmental injustice in Mexico City: A spatial quantile approach","volume":"12","author":"Lome","year":"2020","journal-title":"Expo. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1016\/S0140-6736(16)31726-3","article-title":"Health inequalities: Mexico\u2019s greatest challenge","volume":"388","year":"2016","journal-title":"Lancet"},{"key":"ref_12","first-page":"101228","article-title":"Ethnic inequalities in health intervention coverage among Mexican women at the individual and municipality levels","volume":"43","author":"Armenta","year":"2022","journal-title":"E Clin. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/eurpub\/ckt119","article-title":"Does breast cancer screening level health inequalities out? A population-based study in an Italian region","volume":"24","author":"Pacelli","year":"2014","journal-title":"Eur. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e978","DOI":"10.1016\/S2214-109X(20)30307-7","article-title":"Global disparities in breast cancer outcomes: New perspectives, widening inequities, unanswered questions","volume":"8","author":"Oluwasanu","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_15","first-page":"1121","article-title":"Relationship of Social Determinants of Health with the Three-year Survival Rate of Breast Cancer","volume":"18","author":"Monfared","year":"2017","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_16","first-page":"1428","article-title":"Relationship of socio-economic status, income, and education with the survival rate of breast cancer: A meta-analysis","volume":"48","author":"Taheri","year":"2019","journal-title":"Iran. J. Public Health"},{"key":"ref_17","unstructured":"World Health Organization (2022, November 20). Promedio de Personas por Habitacion en Vivienda Ocupada. Portal Europeo de Informacion Sanitaria. Available online: https:\/\/gateway.euro.who.int\/en\/indicators\/hfa_469-4350-average-number-of-people-per-room-in-occupied-housing-unit\/."},{"key":"ref_18","unstructured":"Singchou, W. (2021). The Housing Crisis in California and Beyond an Insiders Expose, AuthorHouse. Available online: https:\/\/books.google.com.mx\/books?id=MRUMEAAAQBAJ&pg=PT141&lpg=PT141&dq=number+of+rooms+per+household+%2B+LOCKDOWN+%2B+TWO+PERSONS+PER+ROOM&source=bl&ots=aSBUiz2xOc&sig=ACfU3U2BCwY-MyVrpxSqEV0Emq50yV-1ew&hl=es&sa=X&ved=2ahUKEwjTpc7EqOj8AhVXkWoFHVAFCiIQ6AF6BAgfEAM#v=onepage&q=number%20of%20rooms%20per%20household%20%2B%20LOCKDOWN%20%2B%20TWO%20PERSONS%20PER%20ROOM&f=false."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1001\/jama.2009.1993","article-title":"Benefits of screening mammography","volume":"303","author":"Berg","year":"2010","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jhealeco.2014.11.001","article-title":"Does women\u2019s education affect breast cancer risk and survival? Evidence from a population based social experiment in education","volume":"42","author":"Palme","year":"2015","journal-title":"J. Health Econ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1186\/s12939-017-0554-6","article-title":"Increased breast cancer mortality only in the lower education group: Age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983\u20132012","volume":"16","author":"Bahk","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_22","first-page":"51","article-title":"Epidemiological characteristics of and risk factors for breast cancer in the world","volume":"111","author":"Momenimovahed","year":"2019","journal-title":"Breast Cancer Dove Med. Press"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1080\/0284186X.2020.1817548","article-title":"Education, income and risk of cancer: Results from a Norwegian registry-based study","volume":"59","author":"Larsen","year":"2020","journal-title":"Acta Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13690-020-00402-5","article-title":"The influence of education on health: An empirical assessment of OECD countries for the period 1995\u20132015","volume":"78","author":"Raghupathi","year":"2020","journal-title":"Arch. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1477-7819-4-11","article-title":"Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study","volume":"4","author":"Okobia","year":"2006","journal-title":"World J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Medina, N., Callahan, E., Koru-Sengul, T., Maheshwari, S., Liu, Q., Goel, N., and Pinheiro, P.S. (2022). Elevated breast cancer mortality among highly educated Asian American women. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268617"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/01.sla.0000171305.31703.84","article-title":"Patients\u2019 refusal of surgery strongly impairs breast cancer survival","volume":"2","author":"Verkooijen","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/1477-7819-10-118","article-title":"Outcome analysis of breast cancer patients who declined evidence-based treatment","volume":"10","author":"Joseph","year":"2012","journal-title":"World J. Surg. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e022304","DOI":"10.1136\/bmjopen-2018-022304","article-title":"Can unsuccessful treatment in primary medical institutions influence patients\u2019 choice? A retrospective cluster sample study from China","volume":"9","author":"Niu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12939-020-1138-4","article-title":"Vulnerability in health and social capital: A qualitative analysis by levels of marginalization in Mexico","volume":"19","year":"2020","journal-title":"Int. J. Equity Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1080\/07399332.2014.959169","article-title":"Fatalistic Beliefs and Cervical Cancer Screening among Mexican Women","volume":"37","author":"Ehrenzweig","year":"2016","journal-title":"Health Care Women Int."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez, E., Unkart, T., Tao, L., Kroenke, H., Schwab, R., Komenaka, I., and Gomez, S.L. (2017). Prognostic significance of marital status in breast cancer survival: A population-based study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175515"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.ygyno.2021.06.008","article-title":"The impact of marital status on stage at diagnosis and survival of female patients with breast and gynecologic cancers: A meta-analysis","volume":"162","author":"Yuan","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1136\/jech.2005.037606","article-title":"Marital status and longevity in the United States population","volume":"60","author":"Kaplan","year":"2006","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"100642","DOI":"10.1016\/j.ssmph.2020.100642","article-title":"Life expectancy and active life expectancy by marital status among older US adults: Results from the US Medicare Health Outcome Survey (HOS)","volume":"12","author":"Jia","year":"2020","journal-title":"SSM Popul. Health"},{"key":"ref_36","first-page":"116","article-title":"The purported benefits of marriage viewed through the lens of physical health","volume":"16","author":"Rook","year":"2005","journal-title":"Psychol. Inq."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e924858","DOI":"10.12659\/MSM.924858","article-title":"Early Death Incidence and Prediction in Stage IV Breast Cancer","volume":"26","author":"Zhao","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1002\/ijc.10490","article-title":"Family history of breast cancer, age and benign breast disease","volume":"100","author":"Webb","year":"2002","journal-title":"Int. J. Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1159\/000211368","article-title":"Established and suspected risk factors in breast cancer aetiology","volume":"4","author":"Kluttig","year":"2009","journal-title":"Breast Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"465","DOI":"10.5306\/wjco.v5.i3.465","article-title":"Challenges to the early diagnosis and treatment of breast cancer in developing countries","volume":"5","author":"Unger","year":"2014","journal-title":"World J. Clin. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/0969141314563632","article-title":"Decline in breast cancer mortality: How much is attributable to screening?","volume":"22","author":"Njor","year":"2015","journal-title":"J. Med. Screen."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10549-017-4490-3","article-title":"Socioeconomic status and breast cancer treatment","volume":"167","author":"Dreyer","year":"2018","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1002\/cncr.29838","article-title":"Associations among socioeconomic status, patterns of care, and outcomes in breast cancer patients in a universal health care system: Ontario\u2019s experience","volume":"122","author":"Kumachev","year":"2016","journal-title":"Cancer"},{"key":"ref_44","unstructured":"The Global Goals (2022, December 28). Reduce Inequality within and among Countries. The Global Goals. Available online: https:\/\/www.globalgoals.org\/goals\/10-reduced-inequalities\/."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e668","DOI":"10.1016\/S2214-109X(16)30209-1","article-title":"No easy answer for how to tackle Mexico\u2019s health challenges","volume":"4","year":"2016","journal-title":"Lancet Glob. Health"},{"key":"ref_46","unstructured":"Comit\u00e9 de An\u00e1lisis Econ\u00f3mico y del Desarrollo (2022, December 02). Estudios Economicos de la OECD Mexico. OEDC Better Policies for Better Lives. Available online: https:\/\/www.oecd.org\/economy\/surveys\/Mexico-2017-OECD-economic-survey-overview.pdf."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Diggle, P., Heagerty, P., Liang, K., and Zeger, S. (2002). Analysis of Longitudinal Data, Oxford University Press.","DOI":"10.1093\/oso\/9780198524847.001.0001"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"121","DOI":"10.2307\/2531248","article-title":"Longitudinal data analysis for discrete and continuous outcomes","volume":"42","author":"Zeger","year":"1986","journal-title":"Biometrics"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1002\/ijc.28221","article-title":"How much of the deprivation gap in cancer survival can be explained by variation in stage at diagnosis: An example from breast cancer in the East of England","volume":"133","author":"Rutherford","year":"2013","journal-title":"Int. J. Cancer"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/7\/5329\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:06:58Z","timestamp":1760123218000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/7\/5329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,30]]},"references-count":49,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["ijerph20075329"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20075329","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,30]]}}}