title: Disparities in reconstruction rates after mastectomy: patterns of care and factors associated with the use of breast reconstruction in Southern California.
abstract: BACKGROUND
  Many factors influence whether breast cancer patients undergo reconstruction after mastectomy. We sought to determine the patterns of care and variables associated with the use of breast reconstruction in Southern California.
  
  
  METHODS
  Postmastectomy reconstruction rates were determined from the California Office of Statewide Health Planning and Development (OSHPD) inpatient database from 2003 to 2007. International Classification of Disease-9 codes were used to identify patients undergoing reconstruction after mastectomy. Changes in reconstruction rates were examined by calendar year, age, race, type of insurance, and type of hospital using a chi-square test. Univariate and multivariate odds ratios (OR) with 95% confidence intervals (95% CI) were estimated for relative odds of immediate reconstruction versus mastectomy only.
  
  
  RESULTS
  In multivariate analysis, calendar year, age, race, type of insurance, and type of hospital were statistically significantly associated with use of reconstruction. The proportion of patients undergoing reconstruction rose from 24.8% in 2003 to 29.2% in 2007. Patients with private insurance were 10 times more likely to undergo reconstruction than patients with Medi-Cal insurance (OR 9.95, 95% CI 8.46-11.70). African American patients were less likely (OR 0.58, 95% CI 0.46-0.73) and Asian patients one-third as likely (OR 0.37, 95% CI 0.29-0.47) to undergo reconstruction as Caucasians patients Most reconstructive procedures were performed at teaching hospitals and designated cancer centers.
  
  
  CONCLUSIONS
  Although the rate of postmastectomy reconstruction is increasing, only a minority of patients undergo reconstruction. Age, race, type of insurance, and type of hospital appear to be significant factors limiting the use of reconstruction.
authors.affiliation: General and Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, USA. lkruper@coh.org
authors.forename: Laura
authors.initials: L
authors.lastname: Kruper
authors.forename: Alicia
authors.initials: A
authors.lastname: Holt
authors.forename: Xin Xin
authors.initials: XX
authors.lastname: Xu
authors.forename: Lei
authors.initials: L
authors.lastname: Duan
authors.forename: Katherine
authors.initials: K
authors.lastname: Henderson
authors.forename: Leslie
authors.initials: L
authors.lastname: Bernstein
authors.forename: Joshua
authors.initials: J
authors.lastname: Ellenhorn
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D001943:Breast Neoplasms / Q000523:psychology / Q000601:surgery*; D002140:California; D015331:Cohort Studies; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D016462:Mammaplasty / Q000523:psychology / Q000706:statistics & numerical data*; D008408:Mastectomy; D008875:Middle Aged; D010347:Patient Care Planning; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D044465:White People