{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:37:31Z","timestamp":1792240651808,"version":"4.4.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Lymphedema affects up to 34% of patients after breast cancer treatment but remains underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, to determine how socioeconomic status may affect risk for and diagnosis of breast cancer-related lymphedema.<\/jats:p><jats:p>\n          Methods\u2003Records of patients who underwent surgical treatment of breast cancer between 2017\u20132020 were examined. Patients' nine-digit ZIP codes were utilized to determine their deprivation level as a national ADI percentile, and those fitting into the most and least deprived quartiles were compared with evaluate lymphedema risk factors and incidence.<\/jats:p><jats:p>\n          Results\u2003A total of 1,333 breast cancer patients were included, 812 (61%) of whom resided within the most disadvantaged ADI quartile nationally, and 521 within the least disadvantaged quartile. The most deprived group had higher rates of diabetes, obesity, and regional breast cancer, and received more extensive surgeries (7.5% modified radical mastectomy vs 1.9%, p\u2009&lt;\u20090.001) and chemotherapy compared with the least disadvantaged quartile. The most disadvantaged cohort were more often at extreme risk of lymphedema utilizing the Risk Assessment Tool Evaluating Lymphedema Risk (9.1% versus 2.5%, p\u2009&lt;\u20090.001); however, the incidence of lymphedema diagnoses was not significantly higher (13% vs 12%, p\u2009&gt;\u20090.9). Logistic regression showed that the most deprived ADI quartile had 44% lower odds of a lymphedema diagnosis in comparison to the least deprived quartile.<\/jats:p><jats:p>\n          Conclusion\u2003Residing in more socioeconomically disadvantaged neighborhoods is associated with lower odds of a lymphedema diagnosis, despite higher rates of risk factors for lymphedema, suggesting significant underdiagnosis in this population.<\/jats:p>","DOI":"10.1055\/a-1947-8212","type":"journal-article","created":{"date-parts":[[2022,9,20]],"date-time":"2022-09-20T23:52:31Z","timestamp":1663717951000},"page":"444-452","source":"Crossref","is-referenced-by-count":10,"title":["The Association between Breast Cancer Related Lymphedema and Area Deprivation Index"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0965-7100","authenticated-orcid":false,"given":"Sarah N.","family":"Chiang","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Finnan","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2093-5298","authenticated-orcid":false,"given":"Kaamya","family":"Varagur","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary B.","family":"Skolnick","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Sacks","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joani M.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,10,23]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1089\/lrb.2011.0007","article-title":"Prevalence and prognostic significance of secondary lymphedema following breast cancer","volume":"9","author":"S Hayes","year":"2011","journal-title":"Lymphat Res 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lymphedema: The Risk Assessment Tool Evaluating Lymphedema","volume":"213","author":"M N Basta","year":"2017","journal-title":"Am J Surg"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S1470-2045(13)70076-7","article-title":"Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis","volume":"14","author":"T DiSipio","year":"2013","journal-title":"Lancet Oncol"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1055\/s-0040-1710047","article-title":"Microsurgical Strategies for Prophylaxis of Cancer-Related Extremity Lymphedema: A Comprehensive Review of the Literature","volume":"36","author":"J R Rodriguez","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref21","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/QMH.0000000000000297","article-title":"Systematic Undercoding of Diagnostic Procedures in National Inpatient Sample 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consensus on lymphedema diagnosis and treatment","volume":"37","author":"F Lurie"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1089\/wound.2021.0149","article-title":"Guidelines relevant to diagnosis, assessment and management of lymphoedema: a systematic review","volume":"12","author":"E Torgbenu","year":"2023","journal-title":"Adv Wound Care (New Rochelle)"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1055\/s-0037-1599100","article-title":"Systematic Review of the Surgical Treatment of Extremity Lymphedema","volume":"33","author":"H M Carl","year":"2017","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.jseint.2020.11.006","article-title":"National disparities in access to physical therapy after rotator cuff repair between patients with Medicaid vs. private health insurance","volume":"5","author":"E J 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Brayton","year":"2014","journal-title":"PLoS One"},{"issue":"08","key":"ref31","doi-asserted-by":"crossref","first-page":"E2280","DOI":"10.3390\/cancers12082280","article-title":"The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors","volume":"12","author":"M B Aldrich","year":"2020","journal-title":"Cancers (Basel)"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.surg.2019.05.048","article-title":"Improving the quality of life in breast cancer survivors at risk for lymphedema","volume":"166","author":"K L Bland","year":"2019","journal-title":"Surgery"},{"issue":"11","key":"ref33","doi-asserted-by":"crossref","first-page":"765","DOI":"10.7326\/M13-2946","article-title":"Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study","volume":"161","author":"A J Kind","year":"2014","journal-title":"Ann Intern 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with primary radiotherapy","volume":"12","author":"D Larson","year":"1986","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"08","key":"ref37","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1055\/s-0040-1713667","article-title":"Surgical versus Nonsurgical Management of Postmastectomy Lymphedema: A Prospective Quality of Life Investigation","volume":"36","author":"H Darrach","year":"2020","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive 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