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Nipple‐sparing mastectomy (NSM) offers superior esthetic outcomes without sacrificing oncologic safety for select patients requiring mastectomy. While disparities in oncologic care are well established, no study to date has investigated equitable delivery of the various mastectomy types. The objective of this study is to examine multilevel factors related to the distribution of NSM. Patients undergoing mastectomy between 2014 and 2018 across eight hospitals in a single healthcare system were retrospectively reviewed. Patients were categorized by mastectomy type—NSM or other mastectomy (OM). Patient information such as age, race, comorbidities, and median income by ZIP code was collected. Disease characteristics, such as mastectomy weight, breast cancer stage, and treatment history, were identified. Provider and system‐level variables, such as specific provider, hospital of operation, and insurance status, were determined. Bivariate analysis was used to identify variables for inclusion in a backward multivariable model. A cohort of 1202 mastectomy patients was identified, with 388 receiving NSM. The average age was 55.8 years (NSM: 48.8, OM: 59.1, P <.001). 39.8% of white patients (n = 242) and 20.0% of African American patients (n = 88) received NSM (P <.001). Average mastectomy weight was 384.3 (SD 195.7) in the NSM group, compared to 839.4 (SD 521.1) in the OM group (P <.001). 41.4% (n = 359) of patients treated at academic centers, and 6.9% (n = 21) of patients treated at community centers received NSM (P <.001). In the multivariate model, the factor with the largest impact on NSM was specific provider. Odds of NSM decreased by 76%‐88% for certain surgeons, while odds increased by 63 times for one surgeon. This study utilizes a large multi‐institutional database to highlight disparities in NSM delivery. Expectedly, younger, relatively healthy patients, with smaller breast size were more likely to undergo NSM, in accordance with surgical guidelines. However, when all other factors were controlled, provider preferences played the most significant role in NSM delivery rates. These findings demonstrate the need for practice reexamination to ensure equitable access to NSM. [ABSTRACT FROM AUTHOR]

Increased time to mastectomy (TTM) has significant implications for mortality, well‐being, and satisfaction. However, certain populations are subject to disparities that increase TTM. This study examines vulnerable populations and the patient‐, disease‐, provider‐, and system‐level factors related to treatment delays. Patients undergoing mastectomy for breast cancer from 2014 to 2018 across 8 hospitals in a single health care system were retrospectively reviewed. Demographics, disease characteristics, and provider‐ and system‐level information were collected. Time from biopsy‐proven diagnosis to mastectomy was calculated. Univariate analysis identified variables for inclusion in the multivariable model. One thousand, three hundred thirty patients met inclusion. Median TTM was 55.0 days. Factors from all levels—patient, disease, provider, and systemic—were significantly related to disparities. African‐American patients had 11.6% longer TTM compared to white patients (69.0 vs 56.0 days, P <.0001). TTM was 15.5% longer for low‐income patients when compared to high‐income patients (65.0 vs 49.0 days, P =.0014). Preoperative plastic surgery visits led to 19.3% longer TTM (P =.0012); oncologic appointments for neo‐adjuvant chemotherapy led to a 231.0% increase (P <.0001). Average time from last neo‐adjuvant treatment to mastectomy was 44.4 days (SD 26.5); average TTM from diagnosis for patients not receiving neo‐adjuvant chemotherapy was 58.5 days (SD 13.3). Patients with Medicaid waited 14.5% longer compared to patients with commercial insurance (94.0 vs 62.0 days, P =.0005). In our review of care across a large health care system, we identified multiple levels contributing to disparities in TTM. Identification of these disparities offers valuable insight into process improvement and intervention. [ABSTRACT FROM AUTHOR]

Emerging research suggests Black older adults experience a 30% decreased risk for falls compared with their White U.S. counterparts, and this is mediated neither by physical performance nor activity. Fear of falling (FOF) is a significant risk factor for falls, yet we know little about how FOF varies by race/ethnicity. The purpose of this original research brief was to investigate the relationship between race/ethnicity and FOF among older adults. 4,981 community-dwelling Medicare beneficiaries from the National Health and Aging Trends Study (NHATS) who had not self-reported a fall in the past 12 months were analyzed. Logistic regression analyses were conducted to examine the association between race/ethnicity and fear of falling, controlling for sex, age, total annual income, and mobility assistance. FOF differed significantly across racial groups. Black, non-Hispanic older adults were less likely to have FOF (OR =.87, 95% CI =.71,1.07) compared with their White, non-Hispanic counterparts. In the fully adjusted model, this difference persisted and became stronger (adjusted OR =.75, 95%CI =.61,.93). The decreased risk for falls in Black older adults could be explained by lower FOF in this group. These findings should inform public health fall prevention initiatives among community-dwelling older adults. [ABSTRACT FROM AUTHOR]