The impact of rural structural and community health factors on postmastectomy complications among south central Appalachian breast cancer patients.

Abstract

The study examined how structural and community health factors, including primary care physicians (PCP), food insecurity, diabetes, and mortality rate per county, are linked to the number and severity of postmastectomy complications among south central Appalachian breast cancer patients depending on rural status. Data was obtained through a retrospective review of 473 breast cancer patients that underwent a mastectomy from 2017 to 2021. Patient's ZIP Code was used to determine their rural-urban community area code and their county of residence for census data. We conducted a zero inflated Poisson regression. Results demonstrated that patients in small rural/isolated areas with low (B=-4.10, SE=1.93, OR=0.02, p=0.03) to average (B=-2.67, SE=1.32, OR=0.07, p=0.04) food insecurity and average (B=-2.67, SE=1.32, OR=0.07, p=0.04) to high (B=-10.62, SE=4.71, OR=0.00, p=0.02) PCP have significantly fewer postmastectomy complications compared to their urban counterparts. Additionally, patients residing in small rural/isolated areas with high (B=4.47, SE=0.49, d=0.42, p<0.001) diabetes and low mortality (B=5.70, SE=0.58, d=0.45, p<0.001) rates have significantly more severe postmastectomy complications. These findings demonstrate that patients who reside in small/rural isolated areas may experience fewer and less severe postmastectomy when there is certain optimal structural and community health factors present compared to their urban counterparts. Oncologic care teams could utilize this information in routine consult for risk assessment and mitigation. Future research should further examine additional risks for postmastectomy complications.