Racial and Socioeconomic Disparities in Reduction Mammoplasty: An Analysis of Nationwide Inpatient Sample (NIS) Database
Marisa H. Amaral, MD1, Haisar Dao, MD2, Scott Persing, BA1, Joseph H. Shin, MD, FACS1.
1Baystate Medical Center, Springfield, MA, USA, 2St. Elizabeth's Medical Center, Boston, MA, USA.
BACKGROUND: Breast reduction is the most common breast reconstructive procedure performed by plastic surgeons. Interestingly a 12% decline in numbers of these procedures has been recorded by the American Society of Plastic Surgery between 2008 and 2009. The impact of the recession in the United States likely played a major role in this decline, as the unemployment and subsequent loss of insurance have created a marked loss of patient access for this procedure. Additionally, with the pending institution of universal healthcare in the United States, it is predicted that cost containment pressures will no longer permit for Medicare coverage of breast reduction. The purpose of this study is to characterize the patient population that has undergone reduction mammoplasty for symptomatic breast hypertrophy; a clearer understanding of this data should assist in planning for future plastic surgery workforce needs.
METHODS: An analysis of the NIS database from the Healthcare and Utilization Project (HCUP) was performed for 2007. The NIS includes 100% of all discharges from a 20% stratified sample of all U.S. hospitals. ICD-9 codes were used to identify female in-patients with a diagnosis of breast hypertrophy compared to those treated with bilateral reduction mammoplasty. A Chi-square analysis was performed to identify significant differences related to the following variables: Payor mix, race, socioeconomic status and co-morbidities, such as obesity.
RESULTS: Of a total 8,394 female in-patients with breast hypertrophy identified in the NIS database, 5,147 patients (61%) were treated with bilateral reduction mammoplasty. African American and Latino patients with breast hypertrophy were more likely to undergo reduction mammoplasty compared to white patients, with a rate of 4.14 per 100,000 (p<0.0001) and 2.48 per 100,000 (p<0.0001) respectively, compared to a rate of 2.06 per 100,000. Obese females with breast hypertrophy were more likely to undergo reduction mammoplasty than their non-obese counterparts (p<0.0001, 95% CI 1.38-1.84). When considering principal payor as a variable, patients who were insured by private carriers were more likely to be treated surgically than patients with Medicaid coverage (p<0.0001, 95% CI 2.47-3.14). When patients covered by private carriers were compared to patients who are self-payers, however, there was no statistical significance in rate of surgical treatment.
CONCLUSIONS: This study demonstrates disparities in the socioeconomic and racial makeup of patients undergoing breast reduction in the US in 2007. Given the passage of recent federal insurance reform and the coming wave of insurance mandates, the potential implication on plastic surgery procedures is that they will not be considered a medical necessity. We predict that the current disparities revealed in this study may worsen.
Back to Program