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

Annals of Surgical Oncology volume 20, pages 399–406 (2013)Cite this article

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.

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Acknowledgment

The PHC4 is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access to health care for all citizens regardless of ability to pay. PHC4 has provided data to this entity in an effort to further PHC4’s mission of educating the public and containing health care costs in Pennsylvania. PHC4, its agents, and staff, have made no representation, guarantee, or warranty, express or implied, that the data—financial, patient, payor, and physician specific information—provided to this entity, are error-free, or that the use of the data will avoid differences of opinion or interpretation. This analysis was not prepared by PHC4. This analysis was done by the authors. PHC4, its agents and staff, bear no responsibility or liability for the results of the analysis, which are solely the opinion of this entity.

Conflicts of interest

The authors declare no funding or conflicts of interest.

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Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Rachel L. Yang BA, Andrew S. Newman MD, Caroline E. Reinke MD, MSPH, Ines C. Lin MD, Giorgos C. Karakousis MD, Brian J. Czerniecki MD, PhD, Liza C. Wu MD & Rachel R. Kelz MD, MSCE

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  1. Rachel L. Yang BA
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  2. Andrew S. Newman MD
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  3. Caroline E. Reinke MD, MSPH
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  4. Ines C. Lin MD
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  5. Giorgos C. Karakousis MD
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  6. Brian J. Czerniecki MD, PhD
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  8. Rachel R. Kelz MD, MSCE
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Correspondence to Rachel L. Yang BA.

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Yang, R.L., Newman, A.S., Reinke, C.E. et al. Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes. Ann Surg Oncol 20, 399–406 (2013). https://doi.org/10.1245/s10434-012-2607-9

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  • DOI: https://doi.org/10.1245/s10434-012-2607-9

Keywords

  • Policy Change
  • Breast Reconstruction
  • Racial Disparity
  • Black Patient
  • White Patient