Work

Charting Outcomes: The Correlation Between Area of Deprivation Index and Disparities in Breast Reconstruction

Year: 2023

Type: article

Abstract: INTRODUCTION: Breast reconstruction is an important component of breast cancer treatment and recovery. However, disparities exist in the availability and accessibility of healthcare providers and institutions that offer reconstructive services. Past studies have characterized how race, ethnicity, socioeconomic status, insurance policy, and other demographic factors may individually influence access to reconstruction. The Area of Deprivation Index (ADI) is a composite measure that includes data on income, employment, health, education, and crime rates.(1) This value enables policymakers to assess the extent of socioeconomic deprivation within small geographic regions and identify areas that require targeted resource allocation.1 Our objective is to examine the correlation between ADI and the proportion of patients who undergo post-mastectomy reconstruction, as well as the length of time it takes for them to receive treatment. In addition, we aim to assess the utility of ADI as a surrogate for predicting access to reconstructive services. METHODS: Retrospective review identified post-mastectomy patients at NYP-Cornell and Columbia between 1979 and 2019. The list of ADIs for New York City zones are obtained from the Center for Health Disparities Research website. Composite reconstruction rates and average time delay to reconstruction are calculated for each zip code within the NYP breast cancer database and matched with the corresponding district ADI. In general, higher ADI corresponds to increased resource deprivation. Pearson correlation formula is used to assess the dependency of the two measures. Python is used to plot the heatmaps showcasing the proportion of reconstruction, relative time lag, and ADI. RESULTS: We found a negative correlation between the likelihood of undergoing reconstruction and the ADI of the patient’s residential district (R = - 0.081), and a positive correlation between the time delay to reconstruction and increased ADI (R = 0.065). The heatmap distribution corroborates the quantitative trends we observed on correlation analysis. CONCLUSION: The Area of Deprivation Index may provide a preliminary indication of the accessibility of reconstructive services and the expected delay in physician consultation. To address disparities in post-mastectomy breast reconstruction, it is imperative to enhance patient awareness and education, particularly in regions with higher levels of socioeconomic deprivation. Legislative and patient advocacy initiatives should especially focus on areas facing geographic or financial limitations. Additionally, the ADI can aid in monitoring resource allocation and assessing the effectiveness of interventions aimed at promoting equitable access to breast reconstruction. References: 1. Noble, M., Wright, G., Smith, G., & Dibben, C. (2006). Measuring Multiple Deprivation at the Small-Area Level. Environment and Planning A: Economy and Space, 38(1), 169–185. https://doi.org/10.1068/a37168

Source: Plastic & Reconstructive Surgery Global Open

DOI: 10.1097/01.gox.0000992032.11028.df