SP01. Area Deprivation Index and Post-Mastectomy Breast Reconstruction: A Clearer View of Disparities?

PURPOSE: Although access to post-breast cancer reconstructive surgeries continues to improve, inequities in its delivery and utilization still remain. Post-mastectomy reconstruction remains a crucial component of the physical and psychosocial domain of breast cancer care. Previous studies have demonstrated a breast reconstruction care gap, in part fueled by racial and socioeconomic disparities. The purpose of this study is to use Area Deprivation Index (ADI) to assess the full impact of other 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, geography, and distance from the hospital. Population and socioeconomic data were obtained from the United States Census Bureau. ADI was calculated and stratified into quartiles, with Quartile 4 (ADI 75-100) representing the most disadvantaged neighborhoods. Summary statistics were computed, and multivariate regression was used to calculate odds ratios (OR). RESULTS: 2,060 patients underwent mastectomy, of which 737 (36%) underwent immediate breast reconstruction. For every one-unit increase in ADI (increasing neighborhood disadvantage), the odds of receiving breast reconstruction decreased by a factor of 0.988 (OR 0.988, p<0.001). African American, and Asian patients were significantly less likely to undergo breast reconstruction than other racial groups (OR 0.669, p=0.034; OR 0.341, p=0.028, respectively). For every one-year increase in age, the odds of receiving breast reconstruction decreased by a factor of 0.944 (OR 0.944, p<0.001). For every $1 increase in median annual household income, the odds of having breast reconstruction increased by a factor of 1.00 (OR 1.000, p<0.001). Rural patients were significantly more likely to receive breast reconstruction (OR 1.391, p=0.021) than urban patients. For each additional mile that patients lived away from the hospital, their odds of receiving breast reconstruction significantly increased by 0.64% (OR 1.006, p=0.003). CONCLUSION: The use of ADI in numerous recent studies has provided a more inclusive and concrete method to assess the true impact of sociodemographic factors on health care across neighborhoods. We have demonstrated that there are more drivers of this complex gap than household income and race alone; the disparity exists due to a sum of system-wide issues putting individual neighborhoods at highest risk.