The Nationwide Inpatient Sample (NIS) database is part of a family of databases developed under the Healthcare Cost and Utilization Project (HCUP), which is sponsored by the Agency for Healthcare Research and Quality. NIS has provided data to this entity in an effort to further their mission of informing decision-making at the national, state, and community levels by allowing researchers and policymakers to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes.
Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation
Article first published online: 12 APR 2013
Copyright © 2013 American Cancer Society
Volume 119, Issue 13, pages 2462–2468, 01 July 2013
How to Cite
Yang, R. L., Newman, A. S., Lin, I. C., Reinke, C. E., Karakousis, G. C., Czerniecki, B. J., Wu, L. C. and Kelz, R. R. (2013), Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation. Cancer, 119: 2462–2468. doi: 10.1002/cncr.28050
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This analysis was not prepared by NIS. This analysis was prepared by the authors. NIS, its agents, and its staff bear no responsibility or liability for the results of the analysis, which are solely the opinion of this entity.
We acknowledge all of the HCUP Data Partners that contribute to HCUP: Alaska State Hospital and Nursing Home Association, Arizona Department of Health Services, Arkansas Department of Health, California Office of Statewide Health Planning and Development, Colorado Hospital Association, Connecticut Hospital Association, Florida Agency for Health Care Administration, Georgia Hospital Association, Hawaii Health Information Corporation, Illinois Department of Public Health, Indiana Hospital Association, Iowa Hospital Association, Kansas Hospital Association, Kentucky Cabinet for Health and Family Services, Louisiana Department of Health and Hospitals, Maine Health Data Organization, Maryland Health Services Cost Review Commission, Massachusetts Division of Health Care Finance and Policy, Michigan Health and Hospital Association, Minnesota Hospital Association, Mississippi Department of Health, Missouri Hospital Industry Data Institute, Montana Mental Health of America-an Association of Montana Health Care Providers, Nebraska Hospital Association, Nevada Department of Health and Human Services, New Hampshire Department of Health and Human Services, New Jersey Department of Health, New Mexico Department of Health, New York State Department of Health, North Carolina Department of Health and Human Services, Ohio Hospital Association, Oklahoma State Department of Health, Oregon Health Policy and Research, Oregon Association of Hospitals and Health Systems, Pennsylvania Health Care Cost Containment Council, Rhode Island Department of Health, South Carolina State Budget and Control Board, South Dakota Association of Healthcare Organizations, Tennessee Hospital Association, Texas Department of State Health Services, Utah Department of Health, Vermont Association of Hospitals and Health Systems, Virginia Health Information, Washington State Department of Health, West Virginia Health Care Authority, Wisconsin Department of Health Services, and Wyoming Hospital Association.
- Issue published online: 17 JUN 2013
- Article first published online: 12 APR 2013
- Manuscript Accepted: 28 JAN 2013
- Manuscript Revised: 7 JAN 2013
- Manuscript Received: 11 SEP 2012
- breast cancer;
- breast reconstruction;
- health policy;
To improve access to breast reconstruction for mastectomy patients, the United States enacted the Women's Health and Cancer Rights Act in January of 1999. The objective of the current study was to evaluate the impact of this legislation on patients with different insurance plans.
Women aged ≥18 years who underwent mastectomy for cancer were identified in the Nationwide Inpatient Sample database (2000-2009) and were classified according to their immediate breast reconstruction (IBR) status. Trends in rates of IBR were described for each insurance category. Multivariable logistic regression analysis with adjustment for age, race, estimated household income, and Elixhauser comorbidity index was performed to evaluate the relation between insurance status and IBR.
In total, 168,236 patients were identified who underwent a mastectomy during the study interval. Across the 10-year study period, rates of IBR increased 4.2-fold in Medicaid patients, 2.9-fold in Medicare patients, 2.6-fold in privately insured patients, and 2.1-fold in self-pay patients (P < .01). However, after adjustment for confounders, women without private insurance were less likely to undergo IBR compared with women who had private insurance (Medicaid: odds ratio [OR], 0.34; 95% confidence interval [CI], 0.32-0.37; Medicare: OR, 0.53; 95% CI, 0.49-0.58; self-pay: OR, 0.43; 95% CI, 0.37-0.50; other types of nonprivate insurance: OR, 0.64, 95% CI, 0.56-0.73).
After the enactment of policy designed to improve access to IBR, Medicaid and Medicare patients experienced the greatest relative increase in rates of IBR. Although policy changes had the most impact on traditionally underserved populations, disparities still exist. Future studies should endeavor to understand why such disparities have persisted. Cancer 2013;119:2462-2468. © 2013 American Cancer Society.