Premium
Rural‐Urban Differences in Breast Reconstruction Utilization Following Oncologic Resection
Author(s) -
DeCoster Ryan C.,
Bautista Jr RobertMarlo F.,
Burns Jack C.,
Dugan Adam J.,
Edmunds R. Wesley,
Rinker Brian D.,
Webster J. Matthew,
Vasconez Henry C.
Publication year - 2019
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/jrh.12396
Subject(s) - medicine , confidence interval , mastectomy , breast cancer , odds ratio , logistic regression , multivariate analysis , breast reconstruction , demography , rural area , retrospective cohort study , cohort , population , surgery , cancer , environmental health , pathology , sociology
Background Breast reconstruction (BR) is the reconstructive surgical technique that focuses on restoring normal form and function to the breast following oncologic resection. The goal of this study was to determine if BR disparities exist among rural female patients in Kentucky. Methods A retrospective (2006‐2015), population‐based cohort study was conducted on breast cancer patients (stages I‐III) treated with mastectomy with or without BR. We used 2013 Beale codes to stratify patients according to geographic status. Chi‐square tests were used to examine the association of BR along the rural‐urban continuum. A multivariate logistic regression model controlling for patient, disease, and treatment factors was used to predict BR. The likelihood of BR was reported in odds ratios (OR) using a 95% confidence interval (CI). Results Overall, 10,032 patients met study criteria. Of those, 2,159 (21.5%) underwent BR. The rate of BR among urban, near‐metro, and rural patients was 31.1%, 20.4%, and 13.4%, respectively ( P < .001). Multivariate analysis revealed that women from near metro (OR 0.54, CI: 0.47‐0.61; P < .001) and rural areas (OR 0.36, CI: 0.31‐0.41; P < .001) were less likely to undergo BR than women from urban areas. Conclusion Although BR benefits are well documented, women from rural Kentucky undergo BR at lower rates and are less likely to receive BR than their urban counterparts. Efforts should seek to promote equitable access to BR for all patients, including those from rural areas.