Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes.
BACKGROUND
Federal and Pennsylvania state policies instituted in the late 1990s were designed to improve access to postmastectomy breast reconstruction. We sought to evaluate the impact of these policy changes on access to care among racial minorities.


METHODS
Mastectomy patients ≥18 years old were identified in the Pennsylvania Health Care Cost Containment Council inpatient database (1994-2004) and classified by immediate breast reconstruction (IBR) status. Rates of IBR were calculated by patient characteristics and year. Patients were stratified by race before (1994-1997) and after (2001-2004) policy changes, and relative odds of IBR were estimated by univariate and multivariate logistic regression analyses with adjustment for known confounders.


RESULTS
Overall rates of IBR were significantly higher in the time period after policy change compared to before policy change (18.5 vs. 32.7 %, p < 0.01). White, black, and Asian patients all saw a significant rise in rates of IBR. However, after adjustment for potential confounders, black patients, Asian patients, and those of mixed or other races all remained less likely to undergo IBR when compared to white patients after policy changes (odds ratio [OR] 0.66, 95 % confidence interval [CI] 0.55-0.80; OR 0.30, 95 % CI 0.18-0.49; OR 0.29, 95 % CI 0.16-0.51, respectively).


CONCLUSIONS
Rates of IBR increased across all racial groups after policy changes. However, not all races were affected equally, and thus disparities remained. Future studies are needed to investigate the role of other factors, including cultural preferences in utilization of IBR that might explain residual disparities.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. srachel@mail.med.upenn.edu
Rachel L
RL
Yang
Andrew S
AS
Newman
Caroline E
CE
Reinke
Ines C
IC
Lin
Giorgos C
GC
Karakousis
Brian J
BJ
Czerniecki
Liza C
LC
Wu
Rachel R
RR
Kelz
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence*; D006801:Humans; D016462:Mammaplasty / Q000331:legislation & jurisprudence*; D008408:Mastectomy; D008875:Middle Aged; D018579:Patient Selection; D010414:Pennsylvania; D011379:Prognosis; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data*