Race and Breast Cancer Reconstruction: Is There a Health Care Disparity?
Plastic and Reconstructive Surgery
Sharma K et al
Background: Racial disparity continues to be a well-documented problem
afflicting contemporary health care. Because the breast is a symbol of
femininity, breast reconstruction is critical to mitigating the
psychosocial stigma of a breast cancer diagnosis. Whether different
races have equitable access to breast reconstruction remains unknown.
Methods: Two thousand five hundred thirty-three women underwent
first-time autologous versus implant-based reconstruction following
mastectomy. Information regarding age, smoking, diabetes, obesity,
provider, race, pathologic stage, health insurance type, charge to
insurance, and socioeconomic status was recorded. Established statistics
compared group medians and proportions. A backward-stepwise
multivariate logistic regression model identified independent predictors
of breast reconstruction type.
Results: Compared with whites, African Americans were more likely to be
underinsured (p < 0.01), face a lesser charge for reconstruction (p
< 0.01), smoke (p < 0.01), have diabetes (p < 0.01), suffer
from obesity (p < 0.01), live in a zip code with a lower median
household income (p < 0.01), and undergo autologous-based
reconstruction (p = 0.01). On multivariate analysis, only African
American race (OR, 2.23; p < 0.01), charge to insurance (OR, 1.00; p
< 0.01), and provider (OR, 0.96; p < 0.01) independently predicted
type of breast reconstruction, whereas age (OR, 1.02; p = 0.06) and
diabetes (OR, 0.48; p = 0.08) did not.
Conclusions: African American race remains the most clinically
significant predictor of autologous breast reconstruction, even after
controlling for age, obesity, pathologic stage, health insurance type,
charge to patient, socioeconomic status, smoking, and diabetes. Future
research may address whether this disparity stems from patient
preferences or more profound sociocultural and economic forces,
including discrimination.
