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Racial disparities in postmastectomy breast reconstruction following implementation of the affordable care act: A systematic review using a minority health and disparities research framework

Published:January 12, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.013

      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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