title: Health insurance coverage and racial disparities in breast reconstruction after mastectomy.
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.
  
  
  RESULTS
  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.
authors.affiliation: Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota. Electronic address: tshippee@umn.edu.
authors.forename: Tetyana P
authors.initials: TP
authors.lastname: Shippee
authors.affiliation: Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota.
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.affiliation: Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Rowan
authors.affiliation: Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000191:economics / Q000208:ethnology / Q000523:psychology / Q000601:surgery*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016462:Mammaplasty / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data; D008408:Mastectomy / Q000191:economics*; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D058991:Patient Protection and Affordable Care Act; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult