Abstract
Background
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.
Methods
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.
Findings
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.
Conclusions
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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Biography
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.
Biography
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.
Biography
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.
Biography
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.
Article info
Publication history
Accepted:
March 3,
2014
Received in revised form:
February 11,
2014
Received:
November 19,
2013
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
