Socioeconomic differences in labour market attachment after breast cancer: a population-based matched cohort study

Breast cancer survivors face challenges maintaining labor market attachment, potentially impacting their health and economy. Yet, the broader public health impact on how labor market attachment patterns compare with women in the general population by socioeconomic group and disease stage remains unknown. Most previous studies have only included employed women, limiting their relevance for broader population-level planning. This study aimed to address these gaps.

Using Danish registries, we identified women aged 25-55 years diagnosed with stage I-III breast cancer during 2002-2018. For each, we matched 10 comparison women on age, region, and surgery date (index). We assessed sick leave, workforce detachment, and disability pension up to 10 years, emigration, death, or 31 December 2023. We calculated incidence rates and used negative binomial regression to estimate rate differences and ratios, stratified by stage, education, cohabitation, and a social vulnerability index (rSVI, range 0-14, where rSVI < 5 indicated lowest vulnerability).

Among 13,443 breast cancer survivors and 134,430 comparisons, survivors more often had long education, a partner, and a lower rSVI. Breast cancer survivors had higher incidence rates of sick leave 0-2 years after index, but slightly lower rates of workforce detachment and disability pension. From year 3 onwards, rates of all outcomes were slightly higher in breast cancer survivors. Rates of workforce detachment and disability pensions were particularly elevated among survivors with advancing stage and lower socioeconomic position. Notably, the relative estimates were greatest among women with a partner, medium/long education, or lower rSVI.

By assessing labour market outcomes among all breast cancer survivors regardless of their employment status, this study provides population-relevant evidence on the long-term public health consequences of breast cancer. While women with advanced stage and lower socioeconomic position had the highest incidence of work force detachment and disability pension, the greatest relative impact of breast cancer occurred among high-resource survivors-likely reflecting their lower baseline risk.