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

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.