Social Determinants of Health - The Association between Self-rated Global and Mental Health & Socioeconomic Status in Breast Cancer Survivors

Abstract

Background Health is a complex construct that is determined by various factors. Socioeconomic status is one of its determinants and contributes to persisting health inequities. Health differences have been found for people after health shocks. In light of improved treatment outcomes, there is an increasing number of survivors of health shocks. It needs to be assessed if the factors de-termining their health, measured by self-rated health, differ. Approach My aim is to compare the association of socioeconomic status and self-rated health between breast cancer survivors and the general population. Apart from global self-rated health I in-clude self-rated mental health as a major area of concern in breast cancer treatment. I also investigate the impact of social capital and breast cancer treatment on self-rated health. Chronic diseases are sometimes labeled as health shocks; hence I explore and compare this sub sample of the general population. Method Analyses are based on a cross sectional study design comparing data from the general Norwe-gian population and Norwegian breast cancer survivors. Data is retrieved from surveys con-ducted in 2009 and 2012. I mainly use logistic regression analyses. Self-rated global and men-tal health are used as outcome variables. Socioeconomic status is based on income, education and employment status. Social capital is assessed with social network variables. Results I find that breast cancer survivors overall report lower perceived global and mental health. Their health status is not strongly influenced by socioeconomic status or social capital; most treatment variables do not have a significant impact either. For the general population, a strong association can be confirmed. The presence of chronic disease does not significantly change the relationship observed for the overall general population. Conclusion Social determinants of health are important to consider when discussing health inequities. Self-rated health of breast cancer survivors seems to be more strongly influenced by other factors. This needs to be investigated further to optimize care for survivors of breast cancer.