Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota.
Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota.
Womens Health Issues. 2014 May-Jun;24(3):e261-9. doi: 10.1016/j.whi.2014.03.001.
Breast reconstruction after mastectomy offers clinical, cosmetic, and psychological benefits compared with mastectomy alone. Although reconstruction rates have increased, racial/ethnic disparities in breast reconstruction persist. Insurance coverage facilitates access to care, but few studies have examined whether health insurance ameliorates disparities.
We used the Nationwide Inpatient Sample for 2002 through 2006 to examine the relationships between health insurance coverage, race/ethnicity, and breast reconstruction rates among women who underwent mastectomy for breast cancer. We examined reconstruction rates as a function of the interaction of race and the primary payer (self-pay, private health insurance, government) while controlling for patient comorbidity, and we used generalized estimating equations to account for clustering and hospital characteristics.
Minority women had lower breast reconstruction rates than White women (adjusted odds ratio [AOR], 0.57 for African American; AOR, 0.70 for Hispanic; AOR, 0.45 for Asian; p < .001). Uninsured women (AOR, 0.33) and those with public coverage were less likely to undergo reconstruction (AOR, 0.35; p < .001) than privately insured women. Racial/ethnic disparities were less prominent within insurance types. Minority women, whether privately or publicly insured, had lower odds of undergoing reconstruction than White women. Among those without insurance, reconstruction rates did not differ by race/ethnicity.
Insurance facilitates access to care, but does not eliminate racial/ethnic disparities in reconstruction rates. Our findings-which reveal persistent health care disparities not explained by patient health status-should prompt efforts to promote both access to and use of beneficial covered services for women with breast cancer.
与单纯乳房切除术相比，乳房切除术后的乳房重建具有临床、美容和心理益处。尽管重建率有所增加，但种族/民族之间的乳房重建仍存在差异。保险覆盖有助于获得护理，但很少有研究检查健康保险是否能减少差异。
我们使用了 2002 年至 2006 年的全国住院患者样本，以研究医疗保险覆盖范围、种族/民族与接受乳腺癌乳房切除术的女性乳房重建率之间的关系。我们在控制患者合并症的情况下，检查了种族和主要支付者（自付、私人健康保险、政府）之间的相互作用对重建率的影响，我们使用广义估计方程来考虑聚类和医院特征。
少数民族女性的乳房重建率低于白人女性（调整后的优势比[OR]，非裔美国人 0.57；西班牙裔 0.70；亚裔 0.45；p<0.001）。未参保的女性（OR，0.33）和享受公共保险的女性（OR，0.35；p<0.001）比私人保险女性更不可能接受重建。种族/民族差异在保险类型内不太明显。无论是否有私人保险，少数民族女性接受重建的可能性都低于白人女性。在没有保险的人群中，重建率不因种族/民族而异。
保险有助于获得护理，但不能消除重建率的种族/民族差异。我们的发现——揭示了无法用患者健康状况解释的持续存在的医疗保健差异——应该促使人们努力促进妇女获得和使用乳腺癌有益的保险服务。
