title: Disparities in receipt of a laparoscopic operation for ectopic pregnancy among TRICARE beneficiaries.
abstract: Racial disparities in receipt of a laparoscopic operation for ectopic pregnancy are attributed to inequalities in access to care. This study sought to determine if racial disparities in laparoscopic operation for ectopic pregnancy exist among a universally insured population.
  
  
  
  Using 2006-2010 TRICARE (insurance for members of the United States Armed Services and their dependents) data, patients who received a laparoscopic operation or laparotomy for ectopic pregnancy were stratified into direct/military or purchased/civilian system of care. Odds of receipt of a laparoscopic operation in each racial group were compared adjusting for patient demographics, system of care, and severity of ectopic pregnancy.
  
  
  
  Among 3,041 patients in the study sample, 1,878 (61.7%) received laparotomy and 1,163 (38.2%) received a laparoscopic operation within 30 days of diagnosis. Overall, 42.4% of white women received a laparoscopic operation compared with 33.1% of Asian women and 34.9% of black women (P < .001). On multivariable analysis, black women had a 33% lesser odds of receiving a laparoscopic operation (odds ratio: 0.67; confidence interval: 0.55-0.83) compared with white women. These disparities were absent within direct care (odds ratio: 0.93; confidence interval: 0.71-1.21) but were present within purchased care (odds ratio: 0.54; confidence interval: 0.40-0.73).
  
  
  
  Racial minority patients are less likely to receive a laparoscopic operation for ectopic pregnancy despite universal insurance coverage within civilian/purchased care. Further work is warranted to better understand the factors other than insurance access that may contribute to racial disparities in selection of operative approach.
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA. Electronic address: aranjit@bwh.harvard.edu.
authors.forename: Anju
authors.initials: A
authors.lastname: Ranjit
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA.
authors.forename: Muhammad Ali
authors.initials: MA
authors.lastname: Chaudhary
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA.
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA.
authors.forename: Tiannan
authors.initials: T
authors.lastname: Zhan
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Little
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Julian N
authors.initials: JN
authors.lastname: Robinson
authors.affiliation: Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Witkop
mesh_terms: D000293:Adolescent; D000328:Adult; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D008889:Military Personnel; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000208:ethnology* / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States; D044465:White People; D055815:Young Adult