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Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes.
Ann Surg Oncol 2013; 20(2):399-406AS

Abstract

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.

Authors+Show Affiliations

Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. srachel@mail.med.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23054106

Citation

Yang, Rachel L., et al. "Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes." Annals of Surgical Oncology, vol. 20, no. 2, 2013, pp. 399-406.
Yang RL, Newman AS, Reinke CE, et al. Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes. Ann Surg Oncol. 2013;20(2):399-406.
Yang, R. L., Newman, A. S., Reinke, C. E., Lin, I. C., Karakousis, G. C., Czerniecki, B. J., ... Kelz, R. R. (2013). Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes. Annals of Surgical Oncology, 20(2), pp. 399-406. doi:10.1245/s10434-012-2607-9.
Yang RL, et al. Racial Disparities in Immediate Breast Reconstruction After Mastectomy: Impact of State and Federal Health Policy Changes. Ann Surg Oncol. 2013;20(2):399-406. PubMed PMID: 23054106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial disparities in immediate breast reconstruction after mastectomy: impact of state and federal health policy changes. AU - Yang,Rachel L, AU - Newman,Andrew S, AU - Reinke,Caroline E, AU - Lin,Ines C, AU - Karakousis,Giorgos C, AU - Czerniecki,Brian J, AU - Wu,Liza C, AU - Kelz,Rachel R, Y1 - 2012/10/03/ PY - 2012/03/28/received PY - 2012/10/12/entrez PY - 2012/10/12/pubmed PY - 2013/7/31/medline SP - 399 EP - 406 JF - Annals of surgical oncology JO - Ann. Surg. Oncol. VL - 20 IS - 2 N2 - 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. SN - 1534-4681 UR - https://www.unboundmedicine.com/medline/citation/23054106/Racial_disparities_in_immediate_breast_reconstruction_after_mastectomy:_impact_of_state_and_federal_health_policy_changes_ L2 - https://dx.doi.org/10.1245/s10434-012-2607-9 DB - PRIME DP - Unbound Medicine ER -