83. A Comprehensive Analysis of The Impact of Historic Redlining and Area of Deprivation Index on Breast Reduction Outcomes in New York City

PURPOSE: Social determinants of health (SDOH) are recognized as a pivotal aspect of patient care. Various validated measures of SDOH such as redlining and Area of Deprivation Index (ADI), have been well documented in public health literature. While ADI has gained interest in plastic surgery, inadequate literature exists regarding redlining and the combined impact of these two on breast reduction. The present study aims to assess the effects of redlining and ADI on breast reduction outcomes. METHODS: A retrospective review was conducted of all patients who underwent breast reduction between January 2019 and April 2023 at a single institution in New York City. Patient demographics, comorbidities, and complication rates were collected. Redlining was determined by geolocating patient addresses with ArcGIS (Geographic Information System), and plotting them onto the 1930s Home Owner’s Loan Corporation (HOLC) map from the University of Richmond. The ADIs assigned to each census tract were sourced from publicly available data from the University of Wisconsin. State and national ADIs were obtained by converting patient addresses to corresponding census tracts. Chi-square analysis, Fisher’s Exact test, and regression analyses were used to investigate the association between SDOH measures and postoperative complications. RESULTS: A total of 1,061 patients were identified, of which 349 (32.9%) resided in historically redlined communities, 252 (23.8%) in communities with high state ADI (hsADI), defined as state ADI>5, and 59 (5.6%) with high national ADI (hnADI), defined as national ADI>50. A higher rate of current smokers (41.7% versus 31.3%, p=0.011) resided in redlined areas compared to non-redlined areas. Hypertension (41.4% versus 31.3%, p=0.009) and diabetes (48.3% versus 31.9%, p=0.013) were also more prevalent among patients in redlined areas. However, redlining was not statistically associated with any surgical complications. HsADI was associated with seroma (3.2% versus 1.0%, p=0.032) and breast abscess (1.2% versus 0.12%, p=0.04). HnADI was also associated with seroma (6.8% versus 1.2%, p=0.010) and breast abscess (3.4% versus 0.2%, p=0.17). Further analysis was conducted to determine the impact of the combined effect of these measures. Residing in a redlined community with hsADI was associated with wound dehiscence versus communities not meeting this criterion (5.2% versus 1.0%, p=0.030). Redlining with hnADI was associated with any complications (44.4% versus 11.4%, p=0.014), seroma (22.2% versus 11.4%, p=0.007), and breast abscess (12.5% versus 0.29%, p=0.034). Multivariate logistic regression revealed higher odds of any complications in redlined with hnADI communities (OR 5.0, CI 1.05-22.11, p=0.034). Increased odds of wound dehiscence occurred in redlined with hsADI communities (OR 5.44, CI 1.18-18.94, p=0.013). Additionally, higher odds of seroma was exhibited in patients who lived in communities with hsADI (OR 3.55, CI 1.25-10.20, p=0.016), hnADI (OR 5.32, CI 1.34-17.17, p=0.008), and redlining with hnADI (OR 10.06, CI 1.15-57.17, p=0.017). CONCLUSIONS: This is the first study in plastic surgery to examine redlining. Patients who underwent breast reduction and resided in redlined areas with hsADI or HsADI had higher odds of postoperative complications. While the occurrence of surgical complications is multifactorial, it is imperative that providers assess and adequately address SDOH to ensure equitable care.