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Table 3 Fully adjusted associations of baseline sociodemographic, tumour and treatment characteristics with first self-reported ASP

From: Self-reported arm and shoulder problems in breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes cohort study

  No. women with outcome/total Fully adjusted CHR (95%CI)a,b
Shoulder/arm pain Arm stiffness Arm/hand swelling Shoulder/arm pain Arm stiffness Arm/hand swelling
Study site, ethnicity          
Namibia Black 151/380 148/380 81/380 1   1   1 0.001
Namibia Non-Black 25/97 26/97 13/97 0.71 (0.46–1.10)  < 0.0001 0.78 (0.50–1.20) 0.0002 0.68 (0.37–1.24)  
Uganda 214/418 184/418 103/418 2.00 (1.61–2.48)   1.52 (1.21–1.90)   1.59 (1.18–2.15)  
Nigeria 162/383 106/383 84/383 1.88 (1.48–2.39)   1.06 (0.81–1.39)   1.69 (1.21–2.34)  
Zambia 66/198 52/198 38/198 1.19 (0.88–1.61)   0.91 (0.66–1.27)   1.35 (0.90–2.03)  
Age at diagnosis (years)          
 < 50 307/780 255/780 157/780 1 0.06 1 0.23 1 0.10
 ≥ 50 311/696 261/696 162/696 1.18 (0.99–1.39)   1.12 (0.93–1.35)   1.22 (0.96–1.53)  
per 10 years increase 618/1476 516/1476 319/1476 1.04 (0.98–1.11) 0.21 1.04 (0.97–1.11) 0.31 1.04 (0.95–1.13) 0.43
BMI (Kg/m2)          
 < 25 273/637 229/637 129/637 1 0.37 1 0.30 1 0.41
[25–30[ 176/426 144/426 95/426 0.88 (0.72–1.06)   0.89 (0.72–1.09)   1.04 (0.79–1.35)  
30 +  140/342 120/342 80/342 0.99 (0.80–1.21)   1.07 (0.85–1.34)   1.21 (0.91–1.60)  
per 5 kg/m2 increase 618/1476 516/1476 319/1476 1.00 (0.93–1.07) 0.94 1.03 (0.96–1.12) 0.40 1.11 (1.01–1.22) 0.03
Education          
University/technical 106/317 84/317 66/317 1   1   1 0.07
Secondary/high school 196/502 161/502 95/502 1.48 (1.16–1.88)   1.41 (1.08–1.84)   1.08 (0.78–1.49)  
None/Primary school 316/657 271/657 158/657 1.94 (1.51–2.49)   1.77 (1.34–2.33)   1.41 (1.02–1.96)  
Per decrease in educational level 618/1476 516/1476 319/1476 1.38 (1.22–1.56)  < 0.0001 1.32 (1.16–1.51)  < 0.0001 1.20 (1.02–1.41) 0.03
HIV status at breast cancer diagnosis          
Negative/Unknown 562/1332 460/1332 291/1332 1 0.85 1 0.14 1  > 0.99
Positive 56/144 56/144 28/144 0.97 (0.73–1.29)   1.24 (0.93–1.65)   1.00 (0.67–1.49)  
Ever diagnosed with hypertension          
No 432/1050 363/1050 215/1050 1 0.11 1 0.99 1 0.15
Yes 186/426 153/426 104/426 1.17 (0.96–1.42)   1.00 (0.81–1.23)   1.22 (0.93–1.58)  
Tumour stage at diagnosis          
Localized 91/275 79/275 40/275 1  < 0.0001 1  < 0.0001 1  < 0.0001
Locally advanced 413/903 343/903 207/903 1.70 (1.35–2.14)   1.66 (1.29–2.13)   1.98 (1.40–2.79)  
Metastatic 79/203 68/203 48/203 2.44 (1.78–3.33)   2.69 (1.92–3.77)   4.02 (2.59–6.23)  
Prior treatment          
No 105/237 75/221 41/197 1 0.01 1 0.08 1 0.01
Yes 496/1168 429/1184 270/1208 1.37 (1.08–1.72)   1.27 (0.97–1.67)   1.67 (1.16–2.41)  
Prior surgeryc          
No 248/512 185/497 116/482 1 0.01 1 0.21 1 0.19
Yes 309/786 280/801 173/816 0.76 (0.63–0.92)   0.87 (0.70–1.08)   0.83 (0.63–1.09)  
Prior radiotherapy          
No 397/854 316/850 186/825 1 0.60 1 0.22 1 0.59
Yes 147/421 135/425 86/450 1.07 (0.83–1.38)   0.85 (0.65–1.10)   1.10 (0.77–1.59)  
Prior chemotherapy          
No 184/438 133/418 79/400 1 0.0002 1 0.001 1 0.001
Yes 370/873 327/893 206/911 1.48 (1.21–1.82)   1.48 (1.17–1.87)   1.65 (1.22–2.23)  
Prior endocrine therapy          
No 328/703 247/672 151/649 1 0.59 1 0.87 1 0.45
Yes 234/598 218/629 132/652 1.06 (0.86–1.29)   0.98 (0.79–1.22)   0.90 (0.68–1.18)  
Sensitivity analysis conditioned on 6 months survival and excluding metastatic women          
Prior treatment          
Yes vs. No 419/1037 366/1039 214/1045 1.58 (1.14–2.18) 0.01 1.37 (0.95–1.98) 0.10 1.39 (0.86–2.24) 0.18
Prior surgery          
Yes vs. No 280/769 254/771 149/776 0.77 (0.62–0.95) 0.02 0.92 (0.73–1.17) 0.50 0.84 (0.62–1.14) 0.26
Prior radiotherapy          
Yes vs. No 125/382 116/380 76/401 0.83 (0.64–1.09) 0.18 0.70 (0.53–0.92) 0.01 0.91 (0.62–1.32) 0.61
Prior chemotherapy          
Yes vs. No 339/813 300/813 178/821 1.67 (1.31–2.12)  < 0.0001 1.52 (1.17–1.97) 0.002 1.59 (1.12–2.25) 0.01
Prior endocrine therapy          
Yes vs. No 218/576 200/582 118/597 0.97 (0.79–1.19) 0.74 0.99 (0.80–1.23) 0.93 0.87 (0.65–1.15) 0.32
  1. CHR cause-specific hazard ratio, CI confidence interval
  2. aFor study site, age, BMI, education, tumour stage and prior treatment: fully adjusted CHRs are stratified on study site, and adjusted on age (continuous), BMI (categorical), education (continuous), tumour stage (categorical), and prior treatment
  3. bFor Prior surgery, prior radiotherapy, prior chemotherapy, Prior endocrine therapy: fully adjusted CHRs are stratified on study site, and adjusted on age (continuous), BMI (categorical), education (continuous), tumour stage (categorical), and mutually adjusted on each specific treatment type
  4. cOf women who received a surgery and reported an arm/shoulder pain during the follow-up, 84% had a mastectomy. For arm stiffness and arm/hand swelling, these percentages were, respectively, 89% and 87%