Plastic Surgery Research Council

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Influence of Race, Income, Insurance and Education in Rate of Breast Reconstruction: an NCDB 2004-15 Analysis
David J. Restrepo, MD1, Daniel Boczar, MD1, Andrea Sisti, MD1, Maria T. Huayllani, MD1, Jeremie D. Oliver, MD2, Emmanuel Gabriel, MD, PhD1, Sarah McLaughlin, MD1, Brian Rinker, MD1, Antonio J. Forte, Md, PhD1.
1Mayo Clinic, Florida, Jacksonville, FL, USA, 2Mayo Clinic School of Medicine, Rochester, MN, USA.

Influence of Race, Income, Insurance and Education in Rate of Breast Reconstruction: an NCDB 2004-15 Analysis
Purpose-The United States has 3.5 million breast cancer survivors. Breast reconstructive procedures are an important source of hope for those who want to recover their self-esteem and quality of life. We hypothesize that socio-economic disparities such as race, income, insurance coverage and education can affect breast reconstruction rates. The aim of this study is to identify disparities in breast reconstruction and make this information available for the development of future public strategies to reduce disparities.
Methods-We queried the National Cancer Database (NCDB) from 2004-2015 in a retrospective cohort analysis. We included females, older than 18 years of age, with diagnosis of invasive breast cancer or ductal carcinoma in situ that underwent mastectomy. The exclusion criteria that we used were: males, benign breast disease, no surgical procedure, less than 18 years of age. 189,213 patients met the criteria and were included for analysis. This population was then classified by demographic characteristics such as race, ethnicity, income, insurance and education level. The rate of no reconstruction frequencies against any reconstruction was evaluated for disparities.
Results-There was a lower rate of no breast reconstruction among White race (110102/158723, 69.4%) as compared to African American (15514/20734, 74.8%), Native American (461/548, 84.1%) and Asian (4747/6380, 74.4%) (p<0.001). There was a lower rate of no breast reconstruction for patients with an income ≥$46K or $63K (78141/101823, 76.7%) than in patients with an income <$46K or $63K (50324/81166, 62.0%) (p<0.001). The rate of no breast reconstruction in patients with private insurance (56665/99165, 57.1%) was lower when compared to those with government insurance (70733/82508, 85.7%) and patients with no insurance (3341/4001, 83.5%) (p<0,001). There was a lower rate of no reconstruction among patients that reside in zip codes in which <14% of the population did not graduate from high school (45823/72589, 63.1%) compared to: patients that reside in zip codes in which 14%-19.9% did not graduate from high school (30532/42537, 71.8%), patients that reside within a zip code area in which 20%-28.9% of the population did not graduate from high school (30233/40075, 75.4%) and patients that reside within a zip code area in which 29%+ of the population did not graduate from high school (21865/27769, 78.7%) (p<0.001).
Conclusion-Differences in reconstructive rates exist based on race, income, insurance and education level. Further studies need to be conducted in order to identify and mitigate the causes of disparities to this procedure.


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