title: Inequalities in breast cancer reconstructive surgery according to social and locational status in Western Australia.
abstract: OBJECTIVE
  To study the effects of demographic, locational and social status and the possession of private health insurance in Western Australia on the likelihood of women receiving breast reconstructive surgery after surgery for breast cancer.
  
  
  METHODS
  The WA Record Linkage Project was used to extract all hospital morbidity, cancer and death records of women with breast cancer in Western Australia from 1982 to 2001. Comparisons between those receiving and not receiving breast reconstructive surgery were made after adjustment for co-variates in Cox regression.
  
  
  RESULTS
  Overall, 9.1% of women received breast reconstructive surgery after surgery for breast cancer. Women who were younger, with less co-morbidity and non-indigenous women were more likely to receive breast reconstructive surgery. Women in lower socio-economic groups were much significantly less likely to receive breast reconstructive surgery (RR 0.76; 95% CI 0.54-1.06). Women from rural areas were less likely to receive breast reconstructive surgery than those from metropolitan areas (RR 0.54; 95% CI 0.25-1.15) as were those treated in a rural hospital (RR 0.78; 95% CI 0.66-0.92). Treatment in a private hospital (RR 1.25; 95% CI 1.10-1.42) or with private health insurance (RR 1.25; 95% CI 1.08-1.39) independently increased the likelihood of breast reconstructive surgery.
  
  
  CONCLUSIONS
  The rate of breast reconstructive surgery was lower than expected with several factors found to affect the rate; women from disadvantaged backgrounds were less likely to receive breast reconstructive surgery than those from more privileged groups.
authors.affiliation: School of Population Health, University of Western Australia, 35 Stirling Highway, 6009, Crawley, WA, Australia. shall@dph.uwa.edu.au
authors.forename: S E
authors.initials: SE
authors.lastname: Hall
authors.forename: C D J
authors.initials: CD
authors.lastname: Holman
mesh_terms: D001943:Breast Neoplasms / Q000601:surgery*; D003625:Data Collection; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000379:methods; D008489:Medical Indigency; D008875:Middle Aged; D016016:Proportional Hazards Models; D012424:Rural Population / Q000706:statistics & numerical data; D012923:Social Class; D014505:Urban Population / Q000706:statistics & numerical data; D014904:Western Australia