Health insurance coverage and racial disparities in breast reconstruction after mastectomy

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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.

Original languageEnglish (US)
Pages (from-to)E261-E269
JournalWomen's Health Issues
Issue number3
StatePublished - May 2014

Bibliographical note

Funding Information:
Support for this research was provided to the first author by the Fesler-Lampert Chair on Aging, University of Minnesota Center on Aging , and a grant from the National Center for Research Resources of the National Institutes of Health to the University of Minnesota Clinical and Translational Science Institute ( 1KL2RR033182-02 ). Research reported in this manuscript was also supported by the University of Minnesota's Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Program ( 5K12HD055887 ) funded through a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


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