Each 0.05-unit increase in regional Human Development Index reduces mortality risk by 14% (HR=0.861) and recurrence risk by 12% in Chinese women with breast cancer.
Does higher regional Human Development Index improve overall and progression-free survival in Chinese women with breast cancer?
Higher regional socioeconomic development, as measured by the Human Development Index, is independently associated with improved overall and progression-free survival in Chinese women with breast cancer.
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Abstract Background: Breast cancer is the most commonly diagnosed cancer among women in China and globally. Significant regional disparities in survival outcomes have been observed, potentially influenced by socioeconomic development. The Human Development Index (HDI) is a composite measure of health, education, and income that may reflect healthcare access and quality, yet its association with breast cancer prognosis remains unclear in China. Objective: To evaluate the association between regional HDI and survival outcomes in Chinese women with breast cancer, and to quantify the impact of incremental HDI improvement on prognosis. Methods: A multicenter retrospective cohort study included 25,514 patients from 40 cancer centers across 184 prefecture-level cities in China. Regional HDI values were extracted from the China Human Development Report Special Edition. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Survival curves were estimated by using the Kaplan-Meier . Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CI), adjusting for tumor stage, molecular subtype, Ki67 status, age, and pathological type. HDI was analyzed per 0.05-unit increase, corresponding to one standard deviation. Results: Patients in high-HDI regions had significantly better PFS and OS than they in low-HDI. 4-year PFS was 92.4% versus 88.4%, 8-year PFS 86.2% versus 72.6%, and 12-year PFS 83.2% versus 57.9% (log-rank P 0.001). And 4-year OS was 97.0% versus 93.4%, 8-year OS 94.6% versus 87.0%, and 12-year OS 93.2% versus 84.5% (P 0.001). After adjustments, each 0.05-unit increase in HDI was associated with a 14% reduction in mortality risk (HR = 0.861, 95% CI: 0.807-0.919; P 0.001), and the similar reduction was observed for recurrence risk (HR = 0.884, 95% CI: 0.847-0.923; P 0.001). The association remained consistent across molecular subtypes. We provide the first quantitative evidence of the independent association between HDI and both OS and PFS in a national breast cancer cohort. Conclusions: Higher regional HDI is independently associated with improved survival in Chinese women with breast cancer. Each 0.05-unit increase in HDI confers a clinically meaningful survival benefit. These findings underscore the role of socioeconomic development in cancer outcomes and support targeted interventions to reduce regional disparities in care access and quality. Citation Format: W. Wang, Y. Yuan, A. Yuan, Z. Hu, C. Zheng, Z. Zheng, Y. Pan, W. Liang, B. Chen, C. Zhang, Y. Zhang. Human Development Index and Breast Cancer Prognosis in Chinese Women: A Multiregional Survival Analysis abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-28.
Wang et al. (Tue,) reported a other. Each 0.05-unit increase in regional Human Development Index reduces mortality risk by 14% (HR=0.861) and recurrence risk by 12% in Chinese women with breast cancer.