Socioeconomic position and breast reconstruction in Danish women

Figures & data

Figure 1. Formation of the study population of Danish women aged 30–80 years treated by mastectomy for breast cancer in 1999–2006.

Table I. Characteristics of the study population of 13 379 Danish women aged 30–80 years treated by mastectomy for breast cancer in 1999–2006, by educational level.

	Level of education
	Short education n = 4 068 (30%)	Medium education n = 6 428 (48%)	Higher education n = 2 883 (22%)	Total n = 13 379 (100%)
Characteristics	n (%)	n (%)	n (%)	n (%)
Period
1999–2000	1 299 (32)	1 809 (28)	787 (27)	3 895 (29)
2001–2002	1 178 (29)	1 771 (28)	776 (27)	3 725 (28)
2003–2004	881 (22)	1 559 (24)	674 (23)	3 114 (23)
2005–2006	710 (17)	1 289 (20)	646 (22)	2 645 (20)
Age (years)
30–39	53 (1)	315 (5)	223 (8)	591 (4)
40–49	173 (4)	1 190 (19)	709 (25)	2 072 (15)
50–59	777 (19)	202 (31)	934 (32)	3 713 (28)
60–69	1 503 (37)	1 704 (27)	607 (21)	3 814 (29)
70–79	1 562 (38)	1 217 (19)	410 (14)	3 189 (24)
Tumor size (mm)
≤20	1 702 (42)	2 838 (44)	1 403 (49)	5 943 (44)
21–49	2 006 (49)	3 009 (47)	1 239 (43)	6 254 (47)
≥50	360 (9)	581 (9)	241 (8)	1 182 (9)
Spread to lymph nodes
Positive	2 243 (55)	3 713 (58)	1 679 (58)	7 635 (57)
Negative	1 825 (45)	2 715 (42)	1 204 (42)	5 744 (43)
Grade
Ductal grade I	900 (22)	1 271 (20)	551 (19)	2 722 (20)
Ductal grade II	1 494 (37)	2 323 (36)	1 060 (37)	4 877 (36)
Ductal grade III	847 (21)	1 469 (23)	662 (23)	2 978 (22)
Non-ductal	744 (18)	1 226 (19)	548 (19)	2 518 (19)
Unknown	83 (2)	139 (2)	62 (2)	284 (2)
Receptor status
Positive	3 177 (78)	4 979 (78)	2 290 (79)	10 446 (78)
Negative	807 (20)	1 372 (21)	558 (19)	2 737 (20)
Unknown	84 (2)	77 (1)	35 (1)	196 (2)
Menopause
Premenopausal	349 (9)	1 921 (30)	1 254 (44)	3 524 (26)
Postmenopausal	3 719 (91)	4 507 (70)	1 629 (57)	9 855 (74)
Charlson comorbidity index
None	2 927 (72)	5 153 (80)	2 496 (87)	10 576 (79)
1	621 (15)	700 (11)	201 (7)	1 522 (11)
≥2	520 (13)	575 (9)	186 (7)	1 281 (10)
Disposable income
Low (1st quartile)	1 659 (41)	1 191 (19)	269 (9)	3 119 (23)
Middle (2nd–3rd quartile)	2 000 (49)	3 325 (52)	1 208 (42)	6 533 (49)
High (4th quartile)	409 (10)	1 912 (30)	1 406 (49)	3 727 (28)
Affiliation to work market
Working	796 (20)	3 278 (51)	1 929 (67)	6 003 (45)
Unemployed or other	305 (8)	700 (11)	176 (6)	1 181 (9)
Early retirement
pensioner^$	767 (19)	549 (9)	153 (5)	1 469 (11)
Pensioner	1 856 (46)	1 662 (26)	552 (19)	4 070 (30)
Unknown	344 (9)	239 (4)	73 (3)	656 (5)
Cohabiting status
Living with someone	2 560 (63)	4 645 (72)	2 069 (72)	9 274 (69)
Living alone	1 508 (37)	1 783 (28)	814 (28)	4 105 (31)
Surgical treatment
Mastectomy only	3 854 (95)	5 371 (84)	2 269 (79)	11 494 (86)
Immediate breast reconstruction*	15 (0.4)	106 (2)	70 (2)	191 (1)
Delayed breast reconstruction^#	199 (5)	951 (15)	544 (19)	1 694 (13)
Hospital affiliation
No plastic surgery	2 031 (50)	2 889 (45)	1 233 (43)	5 836 (44)
Plastic surgery consultant	683 (17)	771 (12)	322 (11)	2 160 (16)
Plastic surgery department	1 354 (33)	2 768 (43)	1 328 (46)	5 450 (41)

^$Early retirement pension due to illness.

*Performed at same time as mastectomy.

^#Performed at a later time than mastectomy.

Table II. Adjusted odds ratios (ORs) for immediate breast reconstruction according to educational level and plastic surgery services among Danish women aged 30–80 years (n=13 379) treated by mastectomy for breast cancer in 1999–2006.

		Age-adjusted		Adjusted OR*		Adjusted OR, final model^§
	N^#	OR	(95% CI)	OR	(95% CI)	OR	(95% CI)
Education level
Short	15	1.00	–	1.00	–	1.00	–
Medium	106	2.31	(1.33–4.01)	2.29	(1.31–3.99)	2.01	(1.13–3.56)
Higher	70	2.84	(1.60–5.05)	2.68	(1.50–4.80)	2.10	(1.14–3.86)
Hospital affiliation
No plastic surgery	41					1.00	–
Plastic surgery consultant	5					0.47	(0.18–1.19)
Plastic surgery department	145					4.02	(2.81–5.75)

*Adjusted further for tumor characteristics (tumor size, spread to lymph nodes, grade, receptor status, menopause status) and comorbidity (Charlson index).

^§Adjusted further for socioeconomic factors (disposable income, affiliation to work market and cohabiting status) and hospital affiliation.

^#Number of events in given strata.

Table III. Adjusted odds ratios (ORs) for immediate breast reconstruction among Danish women aged 30–80 years (n=13 379) treated by mastectomy for breast cancer in 1999–2006 according to educational level by age group*.

		Age group (years)
		30–44 (n = 1 405)			45–59 (n=4 971)			60–80 (n = 7 003)
	N^#	OR	(95% CI)	N^#	OR	(95% CI)	N^#	OR	(95% CI)
Educational level
Short	4	1.00	–	5	1.00	–	6	1.00	–
Medium	33	0.94	(0.31–2.91)	59	3.59	(1.38–9.34)	14	1.52	(0.54–4.26)
Higher	24	0.95	(0.29–3.08)	42	4.01	(1.49–10.47)	4	1.03	(0.26–4.15)

*Model adjusted for tumor characteristics (tumor size, spread to lymph nodes, grade, receptor status, menopause status), comorbidity (Charlson index), socioeconomic factors (disposable income, affiliation to work market and cohabiting status) and hospital affiliation.

^#Number of events in given strata.

Table IV. Adjusted odds ratios (ORs) for delayed breast reconstruction (within three years of mastectomy) after breast cancer according to educational level and plastic surgery services among Danish women aged 30–80 years (n=11 520) in 1999–2006.

		Age-adjusted		Adjusted OR*		Adjusted OR, final model^§
	N^#	OR	(95% CI)	OR	(95% CI)	OR	(95% CI)
Educational level
Short	137	1.00	–	1.00	–	1.00	–
Medium	730	1.71	(1.40–2.08)	1.69	(1.38–2.07)	1.52	(1.23–1.86)
Higher	414	1.74	(1.40–2.16)	1.67	(1.34–2.08)	1.41	(1.12–1.77)
Hospital affiliation
No plastic surgery	518					1.00	–
Plastic surgery consultant	149					1.13	(0.92–1.39)
Plastic surgery department	614					1.45	(1.26–1.66)

*Adjusted further for tumor characteristics (tumor size, spread to lymph nodes, grade, receptor status, menopause status) and comorbidity (Charlson index).

^§Adjusted further for socioeconomic factors (disposable income, affiliation to work market and cohabiting status) and hospital affiliation.

^#Number of events in given strata.

Table V. Adjusted odds ratios (ORs) for delayed breast reconstruction among Danish women aged 30–80 years (n=11 520) treated by mastectomy for breast cancer in 1999–2006 according to educational level by age group*.

		Age group (years)
		30–44 (n=1 209)			45–59 (n= 4 337)			60–80 (n=5 974)
	N^#	OR	(95% CI)	N^#	OR	(95% CI)	N^#	OR	(95% CI)
Educational level
Short	36	1.00	–	75	1.00	–	26	1.00	–
Medium	231	1.03	(0.65–1.64)	408	1.43	(1.09–1.88)	91	2.45	(1.55–3.89)
Higher	162	1.02	(0.62–1.65)	218	1.32	(0.97–1.78)	34	2.28	(1.30–3.99)

*Model adjusted for tumor characteristics (tumor size, spread to lymph nodes, grade, receptor status, menopause status), comorbidity (Charlson index), socioeconomic factors (disposable income, affiliation to work market and cohabiting status) and hospital affiliation.

^#Number of events in given strata.