Racial disparities in breast reconstruction persist despite the implementation of ACA

Racial disparities in breast reconstruction persist despite the implementation of ACA

Despite steady increases in rates of immediate breast reconstruction (IBR) after mastectomy, racial disparities in IBR have persisted in the years since the implementation of the Affordable Care Act (ACA), a study reports in the May issue ofPlastic and Reconstructive Surgery®,The official medical journal of the American Society of Plastic Surgeons (ASPs). The journal is published in Wolters Kluwer's Lippincott portfolio.

“Our study shows that Hispanic women are more likely to undergo postmastectomy breast reconstruction compared to their non-Hispanic counterparts in the post-ACA era“Comments senior author Rachel E. Schafer, MPH, medical student at Cleveland Clinic Lerner College of Medicine.”However, our analysis demonstrates persistent racial disparities in breast reconstruction care. To better understand these trends, future studies are needed for targeted interventions to ensure equitable reconstructive care for all patients with breast cancer.“

Upward Trends in Breast Reconstruction Under ACA

The researchers used data from the American College of Surgeons' National Surgical Quality Improvement Project to analyze trends in IBR. The analysis focused on the impact of the ACA, which included some provisions - such as: The analysis included 224,506 patients who underwent mastectomies between 2005 and 2008, before passage of the ACA. or 2016-22 after full ACA implementation.

Pre-ACA data showed significant racial disparities in IBR. Reconstruction rates ranged from 35.1% in white patients to 28.8% in Asian patients, 22.3% in Black/African American patients, and 3.8% in American Indian/Alaska Native patients. Patients of Hispanic ethnicity also underwent fewer IBR: 28.0%, compared to 33.4% in non-Hispanic patients.

After ACA implementation, IBR rates increased across racial groups. The largest increases were observed in Native American and Black/African American American Indian and American Indian patients at 27.6% and 24.2%, respectively, compared to a 16.9% increase in White patients. Smaller but significant increases were observed in Asian patients and in patients classified as “other” race. Hispanic patients had a 25.8% increase in IBR versus 14.5% in non-Hispanic patients.

Racial differences remain; Hispanic patients are now more likely to have reconstruction

However, racial minority groups continued to have lower IBR rates in the years since the ACA rollout. In 2016-22, the IBR rate in white patients was 52.0%, compared to 46.5% for Black/African American, 38.7% for Asian, and 31.4% for American Indian/Alaska Native patients. In contrast, Hispanic patients were more likely to undergo IBR compared to non-Hispanic patients: 56.6% versus 45.7%.

The researchers note some important limitations to their study. It cannot take into account the wide range of factors that influence access to reconstructive surgery or the “complex interplay of cultural, social and individual factors” that influence decisions about breast reconstruction.

For patients undergoing mastectomy, breast reconstruction can restore shape and improve patient satisfaction. The new analysis shows "a steady increase in immediate breast reconstruction rates in all minority groups compared to white patients" since the ACA.

“Despite this progress, disparities persist between different racial groups, indicating a complex landscape of reconstructive surgery rates despite legislative efforts“The researchers are writing.”These findings highlight the need for continued efforts to address disparities and empower reconstructive care.“

Sources: