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.
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: Alison P Woods; Marianna V Papageorge; Susanna W L de Geus; Andrea Alonso; Andrea Merrill; Michael R Cassidy; Daniel S Roh; Teviah E Sachs; David McAneny; Frederick Thurston Drake Journal: Ann Surg Oncol Date: 2022-08-06 Impact factor: 4.339
Authors: Jessica R Schumacher; Lauren J Taylor; Jennifer L Tucholka; Samuel Poore; Amanda Eggen; Jennifer Steiman; Lee G Wilke; Caprice C Greenberg; Heather B Neuman Journal: Ann Surg Oncol Date: 2017-08-01 Impact factor: 5.344
Authors: Tracy Onega; Julie Weiss; Karla Kerlikowske; Karen Wernli; Diana Sm Buist; Louise M Henderson; Martha Goodrich; Jennifer Alford-Teaster; Beth Virnig; Anna Na Tosteson; Wendy DeMartini; Rebecca Hubbard Journal: Springerplus Date: 2014-08-08
Authors: David J Restrepo; Maria T Huayllani; Daniel Boczar; Andrea Sisti; Minh-Doan T Nguyen; Jordan J Cochuyt; Aaron C Spaulding; Brian D Rinker; Galen Perdikis; Antonio J Forte Journal: Medicina (Kaunas) Date: 2020-06-08 Impact factor: 2.430