Policy matters| Volume 24, ISSUE 3, e261-e269, May 2014

Health Insurance Coverage and Racial Disparities in Breast Reconstruction After Mastectomy



      Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities.


      We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics.


      Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p < .001). Uninsured women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p < .001) than privately insured women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity.


      Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings—which reveal persistent health care disparities not explained by patient health status—should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer.
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      Tetyana P. Shippee, PhD, is an Assistant Professor in the Division of Health Policy and Management at the University of Minnesota. Her research examines health disparities, quality of care, and aging and long-term care.


      Katy Kozhimannil, MPA, PhD, is Assistant Professor in the Division of Health Policy and Management at the University of Minnesota. She is a health policy analyst who studies institutional and government policies affecting health care delivery, quality, and outcomes for women and families.


      Kathleen Rowan, MPH, is a doctoral student in the Division of Health Policy and Management at the University of Minnesota. She is a health services researcher whose work focuses on mental health policy and social disparities in access to health care.


      Beth Virnig, PhD is a professor and Senior Associate Dean for Academic Affairs and Research in the University Of Minnesota School Of Public Health. Her research examines cancer care effectiveness and quality including end of life care.