title: Race and Breast Cancer Reconstruction: Is There a Health Care Disparity?
abstract: BACKGROUND
  Racial disparity continues to be a well-documented problem afflicting contemporary health care. Because the breast is a symbol of femininity, breast reconstruction is critical to mitigating the psychosocial stigma of a breast cancer diagnosis. Whether different races have equitable access to breast reconstruction remains unknown.
  
  
  METHODS
  Two thousand five hundred thirty-three women underwent first-time autologous versus implant-based reconstruction following mastectomy. Information regarding age, smoking, diabetes, obesity, provider, race, pathologic stage, health insurance type, charge to insurance, and socioeconomic status was recorded. Established statistics compared group medians and proportions. A backward-stepwise multivariate logistic regression model identified independent predictors of breast reconstruction type.
  
  
  RESULTS
  Compared with whites, African Americans were more likely to be underinsured (p < 0.01), face a lesser charge for reconstruction (p < 0.01), smoke (p < 0.01), have diabetes (p < 0.01), suffer from obesity (p < 0.01), live in a zip code with a lower median household income (p < 0.01), and undergo autologous-based reconstruction (p = 0.01). On multivariate analysis, only African American race (OR, 2.23; p < 0.01), charge to insurance (OR, 1.00; p < 0.01), and provider (OR, 0.96; p < 0.01) independently predicted type of breast reconstruction, whereas age (OR, 1.02; p = 0.06) and diabetes (OR, 0.48; p = 0.08) did not.
  
  
  CONCLUSIONS
  African American race remains the most clinically significant predictor of autologous breast reconstruction, even after controlling for age, obesity, pathologic stage, health insurance type, charge to patient, socioeconomic status, smoking, and diabetes. Future research may address whether this disparity stems from patient preferences or more profound sociocultural and economic forces, including discrimination.
  
  
  METHODS
  Risk, III.
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis.
authors.forename: Ketan
authors.initials: K
authors.lastname: Sharma
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis.
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Parikh
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Washington University in St. Louis.
authors.forename: Terence
authors.initials: T
authors.lastname: Myckatyn
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000208:ethnology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology