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Evaluating Breast Reconstruction Equity Using the Social Vulnerability Index: A Single-Institution Cohort Study.

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Summary

The Social Vulnerability Index (SVI) did not predict breast reconstruction delays in this study. However, racial disparities in treatment timing persist, highlighting the need for equitable healthcare practices and policies.

Keywords:
DisparitiesReconstructive outcomesSocial determinants of healthTreatment delay

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Area of Science:

  • Oncology
  • Public Health
  • Health Services Research

Background:

  • Socioeconomic disparities significantly impact breast reconstruction access and outcomes.
  • The Social Vulnerability Index (SVI) provides a standardized measure of community-level vulnerability.
  • Assessing SVI's role in breast reconstruction timing and outcomes is crucial for addressing healthcare inequities.

Purpose of the Study:

  • To evaluate the association between the Social Vulnerability Index (SVI) and the timing of postmastectomy breast reconstruction.
  • To investigate if SVI influences perioperative outcomes in breast reconstruction patients.
  • To identify potential disparities in reconstructive surgery access and timing.

Main Methods:

  • Retrospective cohort study of 264 patients undergoing breast reconstruction post-mastectomy.
  • Geocoding of patient addresses linked to 2020 CDC SVI census tract data.
  • Stratification into SVI quartiles; Kaplan-Meier and Cox models for time-to-treatment analysis, adjusted for covariates.

Main Results:

  • Higher SVI quartiles correlated with increased racial diversity and Medicaid/Medicare coverage.
  • No significant difference in time to earliest treatment was observed across SVI quartiles.
  • Racial disparities were noted, with Black and 'Other' race patients experiencing delays compared to White patients; tumor stage predicted earlier treatment.

Conclusions:

  • SVI was not independently associated with treatment delays or worse outcomes in this cohort.
  • Equitable institutional practices and policies may mitigate structural disparities in reconstructive access.
  • Persistent racial inequities in treatment timing require ongoing attention and targeted interventions.