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Disparities in Urban and Rural Mastectomy Populations

The Effects of Patient- and County-Level Factors on Likelihood of Receipt of Mastectomy

¹ Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
² Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Osler 624, 600 North Wolfe Street, Baltimore, MD 21287, USA
³ Division of Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

Correspondence: Address correspondence and reprint requests to: Lisa K. Jacobs, MD; E-mail: ljacob14{at}jhmi.edu

Background: Using the 2006 Surveillance, Epidemiology, and End Results (SEER) database and the 2004 Area Resource File (ARF), the likelihood of mastectomy for stages I–III breast cancer patients in urban versus rural populations are examined. County and patient level data are evaluated for impact on receipt of mastectomy. Patient variables included age, stage, race, and marital status, and community variables are income, employment, and radiation facility staff density. The likelihood of mastectomy in urban and rural patients, and the impact of the different variables on that procedure, is reported.

Methods: This retrospective analysis of a combined dataset from the 2006 SEER database and the 2004 ARF linked using the federal information processing standard (FIPS) state county variable evaluates patient and county variables with multivariate regression.

Results: From 1992 to 2003, 137,303 patients were identified in the SEER database. The rural population (county population of < 20,000) comprised 9.58% of the overall population. On bivariate analysis, the likelihood of mastectomy was significantly higher among rural patients (59.90% versus 44.92%, P < 0.001). Multivariate analysis demonstrated that rural residency is an independent factor affecting receipt of mastectomy (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.26–1.97). The likelihood that a patient received a mastectomy was impacted by the significant patient factors of stage at diagnosis, race, and marital status, and significant community factors were employment, education level, and density of radiation technologists.

Conclusion: An increased likelihood of mastectomy for rural patients with stages I–III breast cancer is shown with analysis of patient and community factors that may play a role.

Key Words: Mastectomy • Breast cancer • Rural • Urban • Disparity