Disparities in demographics and outcomes of breast cancer in females undergoing mastectomy in rural vs. urban teaching centers.

Abstract

583 Background: Breast cancer (BC) sensitization, awareness, and increased screening have led to significant improvements in prevention, management, and survival rates over the last three decades. Recent reports have shown that the use of prophylactic and therapeutic mastectomy is on the rise. Previous studies have revealed healthcare disparities between rural (RC) and urban teaching centers (UTC), which may influence outcomes. In this retrospective study, we propose to explore the presence of similar disparities among BC patients undergoing mastectomy in rural hospitals vs. UTC. Methods: For this study, we extracted procedures of mastectomy among BC females through the hospitalization records of the National Inpatient Sample (NIS). We stratified our sample into procedures performed at RC and UTC. Procedural and postprocedural complications were compared through multivariable regression models. Results: We studied 75915 BC patients who underwent mastectomy between 2016 and 2022. Around 93.2% of our sample involved procedures performed at UTC, with 6.8% conducted at RC. Procedures at RC involved an older group(mean age 66.18 years vs. 57.19 years, p < 0.01), with a higher Charlson Comorbidity Index (CCI) score(mean score 3.79 vs. 3.53, p < 0.01). An estimated 91.6% of all procedures were performed on an elective basis(88.8% of rural and 91.9% of UTC, p < 0.01). Metastasis was present in 25.5% of all cases (25.4% of UTC and 25.8% of rural cases, p = 0.591). Mastectomies performed at RC had higher odds of bleeding (aOR 1.170, 95% CI 1.075-1.272, p < 0.01), sepsis (aOR 2.163, 95% CI 1.557-3.004, p < 0.01), postprocedural respiratory failure (PPRF) (aOR 2.667, 95% CI 1.479-4.808, p < 0.01), need for mechanical ventilation (MV) (aOR 2.732, 95% CI 1.845-4.046, p < 0.01), ischemic stroke (aOR 5.073, 95% CI 2.884-8.922, p < 0.01), and cardiac arrest (aOR 8.443, 95% CI 4.861-14.666, p < 0.01). Acute kidney injury events were similar (aOR 1.160, 95% CI 0.945-1.423, p = 0.155). The odds of all-cause death were higher among RC procedures (aOR 5.401, 95% CI 3.456-8.442, p < 0.01). Conclusions: The findings of this study have significant implications for healthcare policies. BC patients undergoing mastectomy in rural areas were significantly older and had a higher CCI score. Moreover, rural procedures reported higher risks of bleeding, sepsis, stroke, cardiac arrests, PPRF, MV use, and death. These results highlight the need for additional studies to establish the causes of these disparities, which may reflect the need for improving healthcare services in rural areas. Furthermore, encouraging RC to set up review protocols on their adverse events through Ishikawa diagrams may help identify probable healthcare inequities compared to UTC, which can then be remedied. This research has the potential to influence policy changes that could improve outcomes for rural BC patients.