Rural-Urban Differences in Breast Reconstruction Utilization Following Oncologic Resection

Ryan C. DeCoster, Robert Marlo F. Bautista, Jack C. Burns, Adam J. Dugan, R. Wesley Edmunds, Brian D. Rinker, J. Matthew Webster, Henry C. Vasconez

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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.

Original languageEnglish
Pages (from-to)347-354
Number of pages8
JournalJournal of Rural Health
Issue number3
StatePublished - Jun 1 2020

Bibliographical note

Publisher Copyright:
© 2019 National Rural Health Association


  • breast cancer
  • breast reconstruction
  • health care disparities
  • rural health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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