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Does Area Deprivation Index Provide a Sharper Image of Post-Mastectomy Breast Reconstruction Disparities?
Meeti Mehta, BS; Nerone Douglas, MSc; Elizabeth Moroni, MD, MHA; Carolyn De La Cruz, MD
University of Pittsburgh School of Medicine
2023-02-10
Presenter: Meeti Mehta
Affidavit:
Meeti Mehta
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Although access to post-breast cancer reconstructive surgeries continues to improve, inequities in its delivery and utilization remain. This study uses Area Deprivation Index (ADI) to assess the impact of sociodemographic factors on access and utilization of breast reconstruction.
Methods
This was a retrospective cohort of patients who underwent breast cancer surgery from 2014-2019. Patients were stratified by race, age, ADI, median household income, and geography. ADI was calculated and stratified by the top 25% (most disadvantaged neighborhoods). Summary statistics were computed, and binomial regression was used to calculate relative risks (RR).
Results
5619 patients underwent breast cancer surgery. 568 patients (10.1%) were minority race, 523 (9.3%) lived in rural locations, and 460 (8.2%) had median household incomes < $43,000. 2238 patients (39.8%) lived in neighborhoods with top 25% ADI. Compared to Caucasians, African American and Asian patients had reduced likelihood of breast reconstruction (RR 0.66, CI 0.49-0.91, p=0.009; RR 0.40, CI 0.16-0.98, p=0.04, respectively). Compared to urban patients, rural patients had increased likelihood of reconstruction (RR 1.51, CI 1.23-1.85, p<0.001). Patients with income > $71,000 had greater likelihood of reconstruction compared to lower-income patients (RR 1.19, CI 1.08-1.31, p<0.001). Compared to younger patients, patients > 60 years had reduced likelihood of reconstruction (RR 0.45, CI 0.39-0.51, p<0.001). Patients from top 25% ADI neighborhoods had reduced likelihood of reconstruction compared to patients from lower ADI neighborhoods (RR 0.76, CI 0.68-0.85, p<0.001).
Conclusions
Disparities in breast reconstruction exist due to a sum of system-wide issues putting individual neighborhoods at highest risk.
