Healthcare Policy and Outcomes

Annals of Surgical Oncology

, Volume 20, Issue 2, pp 399-406

First online:

Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes

  • Rachel L. YangAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania Email author 
  • , Andrew S. NewmanAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania
  • , Caroline E. ReinkeAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania
  • , Ines C. LinAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania
  • , Giorgos C. KarakousisAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania
  • , Brian J. CzernieckiAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania
  • , Liza C. WuAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania
  • , Rachel R. KelzAffiliated withDepartment of Surgery, Hospital of the University of Pennsylvania

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Abstract

Background

Federal and Pennsylvania state policies instituted in the late 1990s were designed to improve access to postmastectomy breast reconstruction. We sought to evaluate the impact of these policy changes on access to care among racial minorities.

Methods

Mastectomy patients ≥18 years old were identified in the Pennsylvania Health Care Cost Containment Council inpatient database (1994–2004) and classified by immediate breast reconstruction (IBR) status. Rates of IBR were calculated by patient characteristics and year. Patients were stratified by race before (1994–1997) and after (2001–2004) policy changes, and relative odds of IBR were estimated by univariate and multivariate logistic regression analyses with adjustment for known confounders.

Results

Overall rates of IBR were significantly higher in the time period after policy change compared to before policy change (18.5 vs. 32.7 %, p < 0.01). White, black, and Asian patients all saw a significant rise in rates of IBR. However, after adjustment for potential confounders, black patients, Asian patients, and those of mixed or other races all remained less likely to undergo IBR when compared to white patients after policy changes (odds ratio [OR] 0.66, 95 % confidence interval [CI] 0.55–0.80; OR 0.30, 95 % CI 0.18–0.49; OR 0.29, 95 % CI 0.16–0.51, respectively).

Conclusions

Rates of IBR increased across all racial groups after policy changes. However, not all races were affected equally, and thus disparities remained. Future studies are needed to investigate the role of other factors, including cultural preferences in utilization of IBR that might explain residual disparities.