Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates

American Journal of Surgery
Paris D ButlerJustin P Fox

Abstract

This study evaluates the rates of immediate breast reconstruction (IBR) among racial and insurance status subgroups, in the setting of a changing plastic surgeon workforce. Using state level inpatient and ambulatory surgery data, we identified discharges for adult women who underwent mastectomy for breast cancer. This information was supplemented with plastic surgeon workforce data and aggregated to the health service area-level (HSA). Hierarchical linear models were used to risk standardized IBR rates for 8 race-payer subgroups. The final cohort included 65,246 women treated across 67 HSAs. The plastic surgeon density per 100,000 population directly related to the IBR rate. While all subgroups saw a modest increase in IBR rates, Caucasian women with private insurance realized the largest absolute increase (46%) while African-American and Asian women with public insurance saw the smallest increase (6%). Significant disparities persist in the provision of IBR according to the form of insurance a patient possesses. Of heightened concern is the novel finding that even within privately insured patients, women of color have significantly lower IBR rates compared to Caucasian women.

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Citations

Apr 16, 2019·The Breast Journal·Luis A RibaTed A James
Aug 20, 2020·Women's Health·Bertha Alejandra Martinez-CannonCynthia Villarreal-Garza
Oct 18, 2018·Annals of Surgical Oncology·Jason D WrightDawn L Hershman
Apr 21, 2020·Plastic and Reconstructive Surgery. Global Open·Cody L MullensCristiane M Ueno
Dec 22, 2020·The American Surgeon·Daniel R KirkpatrickRebecca M Tuttle
Dec 15, 2020·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Rachel Xue Ning LeeGeorgette Oni
Feb 26, 2021·American Journal of Surgery·Ava MandelbaumMinna K Lee
Jul 14, 2021·Journal of Racial and Ethnic Health Disparities·Ahmad HamadSamilia Obeng-Gyasi
Jul 17, 2021·Annals of Surgical Oncology·Wasay NizamFabian M Johnston
Jul 22, 2021·Annals of Surgical Oncology·Paris D ButlerAdeyiza O Momoh
Dec 23, 2021·Plastic and Reconstructive Surgery·Sabine OskarAnoushka M Afonso

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