SynthesisInternational journal of epidemiology2009
Breast cancer survival in Canada and the USA: meta-analytic evidence of a Canadian advantage in low-income areas.
Synthesis in International journal of epidemiology, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Association of insurance status among cancer patients and survival outcomes: a systematic review and meta-analysis.International journal for equity in health · 2025Pooled it
- Current Challenges and Disparities in the Delivery of Equitable Breast Cancer Care in Canada.Current oncology (Toronto, Ont.) · 2023Review
- Survival in Women with De Novo Metastatic Breast Cancer: A Comparison of Real-World Evidence from a Publicly-Funded Canadian Province and the United States by Insurance Status.Current oncology (Toronto, Ont.) · 2022Article
- Article
- Bridging the survival gap in cystic fibrosis: An investigation of lung transplant outcomes in Canada and the United States.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2021Article
- Impact of Insurance Status on Survival in Gastroenteropancreatic Neuroendocrine Tumors.Annals of surgical oncology · 2020Article
- ASO Author Reflections: Uninsurance is Associated with Worse Outcomes Following Resection for Gastro-Entero-Pancreatic Neuroendocrine Tumors.Annals of surgical oncology · 2020Article
- Can Health Disparity Be Eliminated? The Role of Family Doctor Played in Shanghai, China.International journal of environmental research and public health · 2020Article
- Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer.JAMA oncology · 2020Article
- Modal lifespan and disparity at older ages by leading causes of death: a Canada-U.S. comparison.Journal of population research (Canberra, A.C.T.) · 2020Article
- Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study.Clinical epidemiology · 2020Article
- Article
- Racial/ethnic differences in survival for patients with gliosarcoma: an analysis of the National cancer database.Journal of neuro-oncology · 2019Article
- A network approach to developing immuno-oncology combinations in Canada.Current oncology (Toronto, Ont.) · 2019Article
- Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis.Journal of public health research · 2019Article
- Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places.Journal of primary care & community health · 2017Article
- Trade-Offs: Pros and Cons of Being a Doctor and Patient in Canada.Journal of general internal medicine · 2017Article
- Insurance Status Is Related to Receipt of Therapy and Survival in Patients with Early-Stage Pancreatic Exocrine Carcinoma.Journal of cancer epidemiology · 2017Article
- Gender differences on the interacting effects of marital status and health insurance on long-term colon cancer survival in California, 1995-2014.Public health · 2016Article
- Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada.International journal for equity in health · 2015Article
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Authors and funding
1 author at 1 institution in 1 country.
Funding
Abstract
backgroundThis study tested the hypothesis that relatively poor Canadian women with breast cancer have a survival advantage over their counterparts in the USA.
methodsSeventy-eight independent retrospective cohort (incidence between 1984 and 2000, followed until 2006) outcomes were synthesized. Fixed effects meta-regression models compared women with breast cancer in low-income areas of Canada and the USA.
resultsLow-income Canadian women were advantaged on survival [rate ratio (RR) = 1.14; 95% confidence interval (CI) 1.13-1.15] and their advantage was even larger among women <65 years of age who are not yet eligible for Medicare coverage in the USA (RR = 1.21, 95% CI 1.18-1.24). Canadian advantages were also larger for node positive breast cancer, which may present with greater clinical and managerial discretion (RR = 1.40, 95% CI 1.30-1.50), and smaller when Hawaii, the state providing the most Canadian-like access, was the US comparator (RR = 1.12, 95% CI 1.01-1.20).
conclusionsMore inclusive health care insurance coverage in Canada vs the USA, particularly among each country's relatively poor people, seems the most plausible explanation for such Canadian advantages. Provision of health care for all Americans would likely prevent countless early deaths, particularly among the relatively poor.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.