Adjusted Hazard Ratios for Breast Cancer Mortality (n = 90,537)
| Characteristic | Unadjusted Hazard Ratio (95% CI) | Adjusted Excluding Stage and Tumor Sizea Hazard Ratio (95% CI) | Adjusted Including Stage and Tumor Sizea Hazard Ratio (95% CI) |
|---|---|---|---|
| Total ambulatory primary care physician visits | |||
| 0–1 (referent) | 1.00 | 1.00 | 1.00 |
| 2–4 | 0.55 (0.52–0.59) | 0.68 (0.64–0.73) | 0.89 (0.82–0.95) |
| 5–10 | 0.50 (0.47–0.53) | 0.61 (0.58–0.65) | 0.83 (0.77–0.89) |
| ≥11 | 0.50 (0.47–0.53) | 0.59 (0.55–0.63) | 0.80 (0.74–0.86) |
| Total ambulatory non– primary care physician visits | |||
| 0–1 (referent) | 1.00 | 1.00 | 1.00 |
| 2–4 | 0.62 (0.58–0.65) | 0.72 (0.68–0.76) | 0.87 (0.81–0.93) |
| 5–10 | 0.56 (0.53–0.59) | 0.66 (0.62–0.72) | 0.83 (0.77–0.89) |
| ≥11 | 0.55 (0.51–0.58) | 0.60 (0.56–0.64) | 0.83 (0.76–0.89) |
| Age at diagnosis | |||
| 67–75 y (referent) | 1.00 | 1.00 | |
| 76–85 y | 1.36 (1.30–1.43) | 1.28 (1.21–1.35) | |
| ≥86 y | 2.19 (2.05–2.33) | 1.85 (1.71–2.00) | |
| Race/ethnicity | |||
| White, non-Hispanic (referent) | 1.00 | 1.00 | |
| Black, non-Hispanic | 1.15 (1.06–1.25) | 1.03 (0.94–1.14) | |
| Hispanic | 1.03 (0.93–1.16) | 0.91 (0.80–1.03) | |
| Asian/American Indian/Pacific Islander | 0.86 (0.74–1.01) | 0.97 (0.81–1.15) | |
| Other | 0.52 (0.36–0.77) | 1.09 (0.94–1.26) | |
| Marital status | |||
| Married (referent) | 1.00 | 1.00 | |
| Never married | 1.36 (1.25–1.48) | 1.22 (1.11–1.35) | |
| Separated/divorced | 1.35 (1.24–1.48) | 1.27 (1.14–1.40) | |
| Widowed | 1.33 (1.26–1.40) | 1.21 (1.14–1.28) | |
| Unknown | 1.15 (1.03–1.29) | 1.09 (0.94–1.26) | |
| Education level of residence | |||
| Quintile 1 (lowest) (referent) | 1.00 | 1.00 | |
| Quintile 2 | 1.02 (0.95–1.09) | 1.08 (0.99–1.16) | |
| Quintile 3 | 0.94 (0.87–1.01) | 0.97 (0.89–1.06) | |
| Quintile 4 | 0.92 (0.84–1.00) | 0.98 (0.89–1.08) | |
| Quintile 5 | 0.88 (0.80–0.97) | 0.92 (0.82–1.03) | |
| Income level of residence | |||
| Quintile 1 (lowest) (referent) | 1.00 | 1.00 | |
| Quintile 2 | 1.00 (0.93–1.07) | 0.97 (0.90–1.05) | |
| Quintile 3 | 1.02 (0.95–1.11) | 0.96 (0.88–1.05) | |
| Quintile 4 | 1.00 (0.92–1.09) | 0.98 (0.89–1.08) | |
| Quintile 5 | 1.03 (0.93–1.14) | 1.03 (0.92–1.16) | |
| MSA of residence | |||
| Large metropolitan (referent) | 1.00 | 1.00 | |
| Metropolitan | 0.99 (0.92–1.06) | 0.98 (0.90–1.06) | |
| Urban | 0.95 (0.85–1.06) | 0.97 (0.86–1.10) | |
| Less urban | 0.92 (0.82–1.02) | 0.96 (0.84–1.09) | |
| Rural | 0.78 (0.65–0.94) | 0.81 (0.66–1.00) | |
| Year of diagnosis | |||
| 1994–1997 (referent) | 1.00 | 1.00 | |
| 1998–2000 | 1.05 (0.99–1.11) | 0.97 (0.91–1.04) | |
| 2001–2005 | 1.06 (1.00–1.13) | 0.93 (0.87–1.00) | |
| Histology type | |||
| Ductal (referent) | 1.00 | 1.00 | |
| Lobular | 0.79 (0.74–0.84) | 0.88 (0.82–0.94) | |
| Ductal/lobular | 1.09 (0.78–1.51) | 1.18 (0.83–1.68) | |
| Favorable | 0.29 (0.24–0.34) | 0.45 (0.38–0.54) | |
| Unfavorable | 1.98 (1.78–2.21) | 1.10 (0.89–1.35) | |
| Undefined | 0.88 (0.78–1.00) | 1.09 (0.95–1.25) | |
| Tumor grade | |||
| Well differentiated (referent) | 1.00 | 1.00 | |
| Moderately differentiated | 2.16 (1.96–2.39) | 1.66 (1.49–1.85) | |
| Poorly differentiated | 4.62 (4.19–5.10) | 2.78 (2.50–3.10) | |
| Undifferentiated | 4.73 (4.04–5.53) | 2.71 (2.28–3.23) | |
| Unknown | 5.07 (4.58–5.62) | 2.23 (1.98–2.51) | |
| Estrogen receptor status | |||
| Positive/borderline (referent) | 1.00 | 1.00 | |
| Negative | 1.52 (1.41–1.64) | 1.62 (1.49–1.75) | |
| Unknown | 1.36 (1.13–1.64) | 1.37 (1.09–1.71) | |
| Progesterone receptor status | |||
| Positive/borderline (referent) | 1.00 | 1.00 | |
| Negative | 1.40 (1.31–1.50) | 1.37 (1.27–1.47) | |
| Unknown | 1.21 (1.00–1.46) | 1.01 (0.81–1.27) | |
| Tumor size (continuous, mm) | 1.006 (1.006–1.006) | ||
| Stage at diagnosis | |||
| I (referent) | – | 1.00 | |
| II | – | 3.38 (3.13–3.64) | |
| III | – | 8.90 (8.12–9.75) | |
| IV | – | 32.34 (29.51–35.43) | |
| Unknown | – | 3.60 (3.25–4.00) | |
| Charlson comorbidity index | |||
| 0 (referent) | 1.00 | 1.00 | |
| 1 | 1.15 (1.08–1.21) | 1.20 (1.13–1.28) | |
| ≥2 | 1.51 (1.42–1.60) | 1.53 (1.43–1.64) | |
| Influenza vaccination | |||
| No (referent) | 1.00 | 1.00 | |
| Yes | 0.79 (0.76–0.83) | 0.92 (0.87–0.97) |
MSA = metropolitan statistical area; SEER = Surveillance Epidemiology and End Results.
Note: Patients with stage 0 carcinoma (in situ) were excluded in the multivariable analysis.
↵a Multivariable Cox proportional models also included indicator variables for SEER Registry location (data not presented).