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01.12.2017 | Research | Ausgabe 1/2017 Open Access

International Journal for Equity in Health 1/2017

Increased breast cancer mortality only in the lower education group: age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983-2012

International Journal for Equity in Health > Ausgabe 1/2017
Jinwook Bahk, Sung-Mi Jang, Kyunghee Jung-Choi
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s12939-017-0554-6) contains supplementary material, which is available to authorized users.



A steadily increasing pattern of breast cancer mortality has been reported in South Korea since the late 1980s. This paper explored the trends of educational inequalities of female breast cancer mortality between 1983 and 2012 in Korea, and conducted age-period-cohort (APC) analysis by educational level.


Age-standardized mortality rates of breast cancer per 100,000 person-years were calculated. Relative index of inequality (RII) for breast cancer mortality was used as an inequality measure. APC analyses were conducted using the Web tool for APC analysis provided by the Division of Cancer Epidemiology and Genetics at the U.S. National Cancer Institute.


An increasing trend in breast cancer mortality among Korean women between 1983 and 2012 was due to the increased mortality of the lower education groups (i.e., no formal education or primary education and secondary education groups), not the highest education group. The breast cancer mortality was higher in women with a tertiary education than in women with no education or a primary education during 1983-1992, and the reverse was true in 1993-2012. Consequently, RII was changed from positive to negative associations in the early 2000s. The lower education groups had the increased breast cancer mortality and significant cohort and period effects between 1983 and 2012, whereas the highest group did not.


APC analysis by socioeconomic position used in this study could provide an important clue for the causes on breast cancer mortality. The long-term monitoring of socioeconomic patterning in breast cancer risk factors is urgently needed.
Additional file 1: Table S1. Total number of female breast cancer death and person-years according to age groups, and % person years for educational groups during1983-2012 in Korea. (DOCX 14 kb)
Additional file 2: Table S2. Age-specific mortality rate per 100,000 person-years during1983-2012 in Korea. (DOCX 14 kb)
Additional file 3: Table S3. Age-standardized (reference population = 2005 census) mortality rate of breast cancer by educational level among Korean women according to 5 year calendar periods between 1983 and 2012. (DOCX 13 kb)
Additional file 4: Table S4. Rate ratios (95% CI) of periods and cohorts by educational level. (DOCX 14 kb)
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