Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Am J Surg. 2018 Jun;215(6):987-994. doi: 10.1016/j.amjsurg.2017.09.037. Epub 2017 Nov 2.
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.
本研究评估了在整形外科医生队伍不断变化的情况下，不同种族和保险状况亚组中即刻乳房重建（IBR）的比率。
我们使用州级住院和门诊手术数据，确定了因乳腺癌接受乳房切除术的成年女性的出院情况。这些信息通过整形外科医生劳动力数据进行补充，并汇总到卫生服务区域（HSA）水平。使用分层线性模型对 8 个种族-支付者亚组的风险标准化 IBR 率进行评估。
最终队列包括 65246 名在 67 个 HSA 接受治疗的女性。每 10 万人中整形外科医生的密度与 IBR 率直接相关。尽管所有亚组的 IBR 率都略有增加，但拥有私人保险的白人女性的绝对增幅最大（46%），而拥有公共保险的非裔美国人和亚裔女性的增幅最小（6%）。
根据患者所拥有的保险形式，IBR 的提供仍存在显著差异。更值得关注的是一个新发现，即在私人保险的患者中，有色人种女性的 IBR 率明显低于白人女性。
