ArticleThe Lancet regional health. Western Pacific2021
Effects of housing value and medical subsidy on treatment and outcomes of breast cancer patients in Singapore: A retrospective cohort study.
Article in The Lancet regional health. Western Pacific, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Socioeconomic and Behavioral Inequalities in Cardiovascular Health: Insights From a Multiethnic Asian Nation.JACC. Asia · 2026Article
- House value as an individual socioeconomic indicator for breast cancer survival and late-stage diagnosis: a population-based cohort study from Northern Ireland.Breast cancer research and treatment · 2026Article
- Singapore Housing Index and prevalence of serious bacterial infections among febrile infants.Frontiers in pediatrics · 2026Article
- Observational
- Implementation, Challenges, and Outlook of an Intergenerational, Layperson-led, Health Coaching Program (HealthStart): A Pilot Case Study.JMIR formative research · 2025Article
- Advancing breast cancer research through real-world data from the Singapore Joint Breast Cancer Registry.ESMO real world data and digital oncology · 2025Article
- Article
- Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study.Resuscitation plus · 2024Article
- Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis.BMC medicine · 2022Article
- Article
- Socioeconomic and demographic determinants of radiation treatment and outcomes in glioblastoma patients.Frontiers in neurology · 2022Article
- Leveraging open data to reconstruct the Singapore Housing Index and other building-level markers of socioeconomic status for health services research.International journal for equity in health · 2021Article
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18 authors.
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Abstract
backgroundSocioeconomic status (SES) is likely to affect survival in breast cancer patients. Housing value is a reasonable surrogate for SES in Singapore where most residents own their own homes, which could be public (subsidised) or private housing. We evaluated effects of housing value and enhanced medical subsidies on patients' presentation, treatment choices, compliance and survival in a setting of good access to healthcare.
methodsA retrospective analysis of breast cancer patients treated in a tertiary hospital cluster from 2000 to 2016 was performed. Individual-level Housing value Index (HI) was derived from each patient's address and then grouped into 3 tiers: HI(high)(minimal subsidy), HI(med)(medium subsidy) and HI(low)(high subsidy). Cox regression was performed to evaluate the associations between overall survival (OS) and cancer-specific survival (CSS) with HI and various factors.
findingsWe studied a multiracial cohort of 15,532 Stage 0-IV breast cancer patients. Median age was 53.7 years and median follow-up was 7.7 years. Patients with lower HI presented with more advanced disease and had lower treatment compliance. On multivariable analysis, compared to HI(high) patients, HI(med) patients had decreased OS (HR=1.14, 95% CI 1.05-1.23) and CSS (HR=1.15, 95% CI 1.03-1.27), and HI(low) patients demonstrated reduced OS (HR=1.16, 95% CI 1.01-1.33). Ten-year non-cancer mortality was higher in lower HI-strata. Enhanced medical subsidy approximately halved treatment noncompliance rates but its receipt was not an independent prognostic factor for survival.
interpretationDespite good healthcare access, lower-HI patients have poorer survival from both cancer and non-cancer causes, possibly due to delayed health-seeking and poorer treatment compliance. Enhanced subsidies may mitigate socioeconomic disadvantages.
fundingNone.
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