Comparison of Survival Outcomes Among Women With Breast Cancer Across Different Health Systems in Veracruz, Mexico

In Mexico, breast cancer (BC) survival is influenced by stage at diagnosis, sociodemographic characteristics, and access to health services. This study aims to compare overall survival and associated sociodemographic and clinical characteristics among women with BC treated in two health systems in Veracruz, Mexico. Clinical records of women diagnosed between 2012 and 2021 were reviewed. A total of 500 medical records were initially screened (250 per institution); after applying inclusion and exclusion criteria, 464 patients were included in the final cohort. Statistical analyses included descriptive statistics, proportions, and mean difference tests. Survival probabilities were estimated using the Kaplan-Meier method, with group comparisons assessed by the log-rank test. Multivariate associations were evaluated using Cox proportional hazards regression adjusted for sociodemographic and clinical variables (age, clinical stage, education level, occupation, area of residence, lymph node involvement, molecular subtype, and health institution). The mean age was 55 ± 12 years. Insured women were more frequently employed, had higher educational attainment, lived in urban areas, and were diagnosed at earlier clinical stages. In contrast, uninsured patients were more often homemakers, had basic education, lived in rural areas, and presented with advanced disease (p ≤ 0.05). Five-year Kaplan-Meier survival was 97.5% (n = 229) among insured patients compared with 83.1% (n = 204) among uninsured patients. In the adjusted Cox model, uninsured patients showed a higher risk of death (hazard ratio (HR) = 4.70; 95% confidence interval (CI): 1.66-13.52). These findings indicate that health insurance status and institutional context are associated with differences in patient characteristics and survival. The results highlight the need to strengthen equity and standardization in care processes to improve early diagnosis and reduce BC mortality in Veracruz.