TY - JOUR
T1 - The Association between Breast Cancer Related Lymphedema and Area Deprivation Index
AU - Chiang, Sarah N.
AU - Finnan, Michael J.
AU - Varagur, Kaamya
AU - Skolnick, Gary B.
AU - Sacks, Justin M.
AU - Christensen, Joani M.
N1 - Publisher Copyright:
© 2022. Thieme. All rights reserved. Thieme Medical Publishers, Inc.,
PY - 2022/6/6
Y1 - 2022/6/6
N2 - Background Lymphedema affects up to 34% of patients after breast cancer treatment but remains underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, to determine how socioeconomic status may affect risk for and diagnosis of breast cancer-related lymphedema. Methods Records of patients who underwent surgical treatment of breast cancer between 2017–2020 were examined. Patients’ nine-digit ZIP codes were utilized to determine their deprivation level as a national ADI percentile, and those fitting into the most and least deprived quartiles were compared with evaluate lymphedema risk factors and incidence. Results A total of 1,333 breast cancer patients were included, 812 (61%) of whom resided within the most disadvantaged ADI quartile nationally, and 521 within the least disadvantaged quartile. The most deprived group had higher rates of diabetes, obesity, and regional breast cancer, and received more extensive surgeries (7.5% modified radical mastectomy vs 1.9%, p < 0.001) and chemotherapy compared with the least disadvantaged quartile. The most disadvantaged cohort were more often at extreme risk of lymphedema utilizing the Risk Assessment Tool Evaluating Lymphedema Risk (9.1% versus 2.5%, p < 0.001); however, the incidence of lymphedema diagnoses was not significantly higher (13% vs 12%, p > 0.9). Logistic regression showed that the most deprived ADI quartile had 44% lower odds of a lymphedema diagnosis in comparison to the least deprived quartile. Conclusion Residing in more socioeconomically disadvantaged neighborhoods is associated with lower odds of a lymphedema diagnosis, despite higher rates of risk factors for lymphedema, suggesting significant underdiagnosis in this population.
AB - Background Lymphedema affects up to 34% of patients after breast cancer treatment but remains underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, to determine how socioeconomic status may affect risk for and diagnosis of breast cancer-related lymphedema. Methods Records of patients who underwent surgical treatment of breast cancer between 2017–2020 were examined. Patients’ nine-digit ZIP codes were utilized to determine their deprivation level as a national ADI percentile, and those fitting into the most and least deprived quartiles were compared with evaluate lymphedema risk factors and incidence. Results A total of 1,333 breast cancer patients were included, 812 (61%) of whom resided within the most disadvantaged ADI quartile nationally, and 521 within the least disadvantaged quartile. The most deprived group had higher rates of diabetes, obesity, and regional breast cancer, and received more extensive surgeries (7.5% modified radical mastectomy vs 1.9%, p < 0.001) and chemotherapy compared with the least disadvantaged quartile. The most disadvantaged cohort were more often at extreme risk of lymphedema utilizing the Risk Assessment Tool Evaluating Lymphedema Risk (9.1% versus 2.5%, p < 0.001); however, the incidence of lymphedema diagnoses was not significantly higher (13% vs 12%, p > 0.9). Logistic regression showed that the most deprived ADI quartile had 44% lower odds of a lymphedema diagnosis in comparison to the least deprived quartile. Conclusion Residing in more socioeconomically disadvantaged neighborhoods is associated with lower odds of a lymphedema diagnosis, despite higher rates of risk factors for lymphedema, suggesting significant underdiagnosis in this population.
KW - breast cancer
KW - breast cancer-related lymphedema
KW - breast reconstruction
KW - lymphedema
KW - mastectomy
KW - social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85139187569&partnerID=8YFLogxK
U2 - 10.1055/a-1947-8212
DO - 10.1055/a-1947-8212
M3 - Article
C2 - 36126960
AN - SCOPUS:85139187569
SN - 0743-684X
VL - 39
SP - 444
EP - 452
JO - Journal of reconstructive microsurgery
JF - Journal of reconstructive microsurgery
IS - 6
ER -