Moss Whitney D, King Brody W, Memmott Stanley, Pires Giovanna, Rosales Megan, Kwok Alvin, Tenzel Paul
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine.
University of Utah School of Medicine.
Ann Plast Surg. 2023 Feb 1;90(2):114-117. doi: 10.1097/SAP.0000000000003212. Epub 2022 Apr 20.
Racial disparities in plastic surgery limit health care accessibility and quality. The aim of this study is to determine if racial disparities exist within patient-targeted advertising materials on academic plastic surgery practice (APSP) Web sites and if disparities are more pronounced in specific categories within plastic surgery.
Throughout May 2021, 3 independent reviewers analyzed the Web sites for APSPs and identified all photos, videos, and graphics with visible skin. For each image, the Fitzpatrick skin tone scale was used to classify the skin tone as "White" (I-III) or "non-White" (IV-VI). The images were further categorized based on the type of procedure depicted. Comparisons were made to publish US census data using χ 2 tests and linear mixed effects models.
In total, 4615 images were analyzed from 100 APSP Web sites. Seven hundred eighty (16.9%) portrayed non-White skin tone, which was significantly less than expected based on US census data (23.7% non-White race) ( P < 0.001). Online representation had the starkest disparity in hand surgery (8.65% non-White) and adult craniofacial (9.74% non-White). The only categories that showed no significant difference between representation and demographics included implant-based breast reconstruction ( P = 0.32) and pediatric craniofacial ( P = 0.93). Overall, the marketing materials demonstrated significantly lower representation of non-White skin compared with the census demographics by an absolute difference of -4.71% ( P < 0.001).
Non-White patients are significantly underrepresented in advertising materials published by APSPs, indicating systemic racial biases. Patient-targeted advertising can be improved to promote equality in representation for patients seeking plastic and reconstructive surgery.
整形手术中的种族差异限制了医疗保健的可及性和质量。本研究的目的是确定在学术整形手术实践（APSP）网站上针对患者的广告材料中是否存在种族差异，以及这些差异在整形手术的特定类别中是否更为明显。
在2021年5月期间，3名独立评审员分析了APSP的网站，并识别出所有可见皮肤的照片、视频和图形。对于每张图像，使用菲茨帕特里克肤色量表将肤色分类为“白色”（I - III型）或“非白色”（IV - VI型）。这些图像根据所描绘的手术类型进一步分类。使用卡方检验和线性混合效应模型与已公布的美国人口普查数据进行比较。
总共从100个APSP网站分析了4615张图像。780张（16.9%）描绘了非白色肤色，这明显低于根据美国人口普查数据预期的比例（非白人种族占23.7%）（P < 0.001）。在线展示在手部手术（非白人占8.65%）和成人颅面手术（非白人占9.74%）方面的差异最为明显。唯一在展示与人口统计数据之间没有显著差异的类别包括基于植入物的乳房重建（P = 0.32）和小儿颅面手术（P = 0.93）。总体而言，与人口普查数据相比，营销材料中非白色皮肤的展示比例显著更低，绝对差异为 - 4.71%（P < 0.001）。
非白人患者在APSP发布的广告材料中明显代表性不足，表明存在系统性的种族偏见。可以改进针对患者的广告，以促进寻求整形和重建手术的患者在代表性方面的平等。
