Using the Area Deprivation Index to Assess the Role of Social Factors in Shaping Access and Utilization of Breast Reconstruction.

Abstract

Introduction: Although access to post-breast cancer reconstructive surgeries continues to improve, inequities remain. This study uses Area Deprivation Index (ADI) to assess the impact of sociodemographic factors on access and utilization of breast reconstruction (BR).

Methods: This was a retrospective cohort of patients who underwent breast cancer surgery from 2014 to 2019. Patients were stratified by ADI, race, age, median household income, geography, and distance from the hospital. Summary statistics were computed, and multivariate regression was used to calculate odds ratios (OR).

Results: A total of 2060 patients underwent mastectomy, of which 737 (36%) underwent immediate BR. For every one-unit increase in ADI, the odds of having BR decreased by 1.2% (OR, 0.988; CI, 0.985-0.992; P < 0.001). African American and Asian patients were significantly less likely to undergo reconstruction than other racial groups (OR, 0.669; CI, 0.456-0.963; P = 0.034 and OR, 0.341; CI, 0.114-0.819; P = 0.028, respectively). For every 1-year increase in age, the odds of receiving BR decreased by 5.6% (OR, 0.944; CI, 0.936-0.951; P < 0.001). For every $10 increase in median annual household income, the odds of having BR increased by 7.2% (OR, 1.007; CI, 1.005-1.009; P < 0.001). Rural patients were significantly more likely to receive reconstruction (OR, 1.391l; CI, 1.049-1.838; P = 0.021) than urban patients. As patients' distance from the hospital increased, White patients were more likely to receive BR (OR, 1.035; CI, 1.0003-1.0713; P = 0.048), whereas non-White patients were less likely to receive BR (OR, 0.965; CI, 0.933-0.999; P = 0.048). There were varying relationships between each measure of disparity and BR types.

Conclusions: Disparities in BR exist due to a sum of system-wide issues putting individual neighborhoods at highest risk.