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Inequities in Breast Cancer Outcomes in Chile: An Analysis of Case Fatality and Survival Rates (2007–2018)
14 Pages Posted: 18 Nov 2022More...
Introduction: Breast cancer (BC) is one of the most common cancers in women worldwide and in Chile. Due to the lack of a Chilean national cancer registry, there is partial information on the status of breast cancer in the country.
Aims: To study inequities in BC health care outcomes for Chilean women, including case fatality rates and survival rates in Chilean women, stratified by type of health care insurance provider and geographical area.
Methods: We used two public anonymized databases provided by the Department of Health Statistics and Information of the Ministry of Health: the national death and hospital discharges datasets. Survival analysis, we used the Kaplan Meier product–limit estimator with a 95% confidence interval and the Cox proportional hazards model for studying the effects of covariates with null–hypothesis significance testing of 𝑝 > 0.001. Fatality rates was obtained from previously calculated incidence and mortality.
Results: We considered a cohort of 58,254 and 16,615 BC hospital discharges and deaths for the period 2007–2018. The national fatality rate has remained relatively constant over time, with a mean of 26.8 and a standard deviation of 1.1. However, women affiliated with ISAPRE had a considerably lower fatality rate during the period under study, with an average of 15.7 compared to 27.5 for women affiliated with FONASA. The 95% confidence intervals for the one-year survival rate were [0.931 ± 0.002] for FONASA, [0.972 ± 0.003] for the ISAPRE patients, and [0.940 ± 0.002] when considering all women combined. The 95% confidence intervals for the five-year survival rates were [0.806 ± 0.004], [0.901 ± 0.007], and [0.827 ± 0.004] for FONASA, ISAPRE and all women, respectively. Women from the Metropolitan region have higher survival rates than women from other regions. Survival rates obtained using the Cox proportional hazards model have a similar behavior to those obtained by the Kaplan–Meier estimations.
Discussion: Despite the inclusion of breast cancer within the set of pathologies selected for the GES plan in 2005 with the goal of providing greater equity for all patients, there are still significant differences in case fatality and survival rates for patients affiliated with a private provider compared to those in the public system, a choice that is directly associated with socioeconomic level. The same disparity is observed between patients in the Metropolitan and other regions. Further studies are required to determine the causes of these disparities, such as differences in compliance with screening recommendations and general health status.
Funding Information: T he authors gratefully acknowledge financial support from ANID PIA/APOYO AFB180003 and CMM-Conicyt PIA AFB170001.
Declaration of Interests: We declare no conflict of interest.
Ethics Approval Statement: This work used publicly available data from the Chilean Ministry of Health through the Department of Health Statistics and Information. All data were protected, and personal information was anonymized; therefore, no consent from participants was needed.
Keywords: breast cancer, case fatality rates, survival rates, health care inequalities, Chilean health care system
Suggested Citation: Suggested Citation