Disparity Reduction in U.S. Breast Reconstruction: An Analysis from 2005 to 2017 Using 3 Nationwide Data Sets.

BACKGROUND

Following passage of the Women's Health and Cancer Rights Act of 1998 (WHCRA), a steady rise in breast reconstruction rates was reported; however, a recent update is lacking. This study aimed to evaluate longitudinal trends in breast reconstruction (BR) rates in the United States and relevant sociodemographic factors.

METHODS

Mastectomy cases with and without BR from 2005 through 2017 were abstracted from the National Surgical Quality Improvement Program database; the Surveillance, Epidemiology, and End Results Program database; and the National Cancer Database (NCDB). BR rates were examined using Poisson regression. Multivariable logistic regression analysis of NCDB data were used to identify predictors of reconstruction. Race and insurance distributions were evaluated over time.

RESULTS

Of 1,554,381 mastectomy patients, 507,631 (32.7%) underwent BR. Annual reconstruction rates per 1000 mastectomies increased from 2005 to 2012 (National Surgical Quality Improvement Program incidence rate ratio [IRR], 1.077; Surveillance, Epidemiology, and End Results Program IRR, 1.090; and NCDB IRR, 1.092) and stabilized from 2013 to 2017. NCDB data showed that patients who were younger (≤59 years), privately insured, had fewer comorbidities, and underwent contralateral prophylactic mastectomy were more likely to undergo BR (all P < 0.001). Over time, the increase in BR rates was higher among Black (252.3%) and Asian (366.4%) patients than among White patients (137.3%). BR rates increased more among Medicaid (418.6%) and Medicare (302.8%) patients than among privately insured patients (125.3%).

CONCLUSIONS

This analysis demonstrates stabilization in immediate BR rates over the past decade; reasons behind this stabilization are likely multifactorial. Disparities based on race and insurance type have decreased, with a more equitable distribution of BR rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.