Nguyen Antoinette T, Duckworth Emily, Kandi Lyndsay, Li Rena A, Williams Tokoya, Coles Brigid, Galiano Robert D
University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
University of South Carolina School of Medicine Greenville, Greenville, SC, USA.
Ann Surg Oncol. 2025 Jun;32(6):4041-4052. doi: 10.1245/s10434-025-17005-5. Epub 2025 Feb 12.
Disparities in healthcare access and outcomes are well documented among racial and ethnic minority groups in the USA, with American Indian/Alaska Native (AI/AN) women experiencing significant barriers to postmastectomy breast reconstruction. This systematic review and meta-analysis of 11 studies highlights these disparities, revealing that AI/AN women are significantly less likely to undergo reconstruction compared with non-Hispanic white women (pooled OR 0.47, 95% CI 0.34-0.66). Contributing factors include geographic isolation, socioeconomic barriers, limited access to reconstructive surgeons, and cultural influences shaped by historical trauma and systemic inequities. Geographic and financial challenges are compounded by inadequate healthcare infrastructure and low rates of culturally sensitive outreach. Addressing these disparities requires targeted interventions such as enhanced healthcare access in rural areas, policy reforms to improve insurance coverage, and culturally tailored patient education initiatives.
美国不同种族和族裔少数群体在医疗保健可及性和治疗结果方面的差异有充分记录，美国印第安人/阿拉斯加原住民（AI/AN）女性在乳房切除术后乳房重建方面面临重大障碍。这项对11项研究的系统评价和荟萃分析突出了这些差异，表明与非西班牙裔白人女性相比，AI/AN女性进行重建的可能性显著降低（合并比值比0.47，95%置信区间0.34-0.66）。促成因素包括地理隔离、社会经济障碍、获得重建外科医生的机会有限，以及受历史创伤和系统性不平等影响的文化因素。地理和财政挑战因医疗保健基础设施不足以及文化敏感外展率低而更加复杂。解决这些差异需要有针对性的干预措施，如加强农村地区的医疗保健可及性、进行政策改革以改善保险覆盖范围，以及开展文化上量身定制的患者教育倡议。
