Highlights
- •Promising strategies for racial equity in breast reconstruction are identified.
- •Black women are 9.1% less likely than white women to receive breast reconstruction.
- •A public health framework is used to assess root causes of these disparities.
- •Implicit bias, communication barriers, and infrastructure are contributors.
- •Interventions are proposed at individual, interpersonal, community, societal levels.
Abstract
Background
This systematic review assesses racial disparities for African American (AA) women
in breast reconstruction following the implementation of the Affordable Care Act.
Methods
Four databases (Ovid Medline, PubMed, Scopus, Web of Science) were searched for peer-reviewed
articles published between January 2011 and September 2021.
Results
Out of 917 screened articles, 61 were included. The most common metrics were breast
reconstruction rates (57.4%) and clinical outcomes (14.8%). Pooled reconstruction
rates were 45.7% in white and 38.5% in AA women. 95.1% of studies found disparities
in breast reconstruction rates. The greatest influencers on reconstruction rates were
individual interactions in the healthcare system (54%), sociocultural environment
(39%), behavioral factors (31%), and community interactions with the healthcare system
(36%).
Conclusion
Racial disparities in postmastectomy breast reconstruction persist. Focusing on implicit
bias, communication barriers and infrastructure are the most promising strategies
to create equitable access to breast reconstruction for AA women.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
January 11,
2023
Received in revised form:
January 3,
2023
Received:
November 13,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
