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Neighborhood Disadvantage Predicts Delay in Care in Bilateral Breast Reduction
Victoria G Zeyl1, Krissia M Rivera Perla2, Raman Mehrzad3
1From the Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN.
Purpose:
The Area Deprivation Index (ADI) is a validated quantifiable measure of neighborhood disadvantage and social determinants of health (SDoH). Higher percentiles in ADI correlate with the most disadvantaged neighborhoods: lower income, lower education, and less access to transportation. Using ADI, we aimed to investigate the impact of SDoH on bilateral breast reduction (BBR) complication rates.
Methods:
A retrospective study of BBR patients from 2015 to 2021 was conducted. Patient addresses were matched to ADI percentiles and grouped into most (top 80% ADI) and least disadvantaged. Multivariable regressions were used to compare postoperative treatment between groups and adjust for confounders.
Results:
In total, 568 patients were analyzed and 47% were high ADI. Time-to-event analysis revealed a 155% (β = 2.55; CI, 1.87-3.48; P < 0.001) increase in time to presentation for treatment of wound-related complications among higher-deprivation patients compared to their lower-deprivation counterparts. This difference in time to presentation equated to approximately 3 days overall when comparing higher to lower deprivation patients; however, this difference between the groups increased to 12 days when comparing those who experienced wound-related complications beyond day 30.
Conclusions:
High deprivation was associated with increased delays to treatment after complications. More research is needed to determine the factors that impact postoperative courses among high ADI patients.
