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More Parity in Breast Reconstruction Seen With Medicaid Expansion

TUESDAY, May 4, 2021 -- Medicaid expansion was associated with increases in breast reconstruction rates among non-Hispanic Black (NHB) women, according to a study presented at the annual meeting of the American Society of Breast Surgeons, held virtually from April 29 to May 2.

Kirithiga Ramalingam, M.D., from Loma Linda University Health in California, and colleagues selected all NHB and non-Hispanic White (NHW) breast cancer patients older than 40 years who underwent mastectomy with or without reconstruction from 2010 to 2017 from the National Cancer Database and examined the effect of Medicaid expansion on utilization of breast reconstruction.

The researchers found that 13.49 percent of 1,196,859 patients underwent reconstruction. The proportion of patients undergoing reconstruction increased and peaked at 13.83 percent in 2013 and then decreased. The odds of undergoing reconstruction were significantly higher for patients who were younger, were NHW, had higher income or education levels, had a lower comorbidity index, were insured, and had nonmetastatic disease. In nonexpansion states, the proportion of patients who underwent reconstruction was lower for NHB versus NHW patients in all years, with the smallest disparity (−1.39 percent) in 2017. The proportion of NHB patients who underwent reconstruction exceeded that of NHW patients for the first time in 2014, in 2015, and in 2017 (+0.21, +0.28, and +0.19 percent, respectively) in early expansion states, in 2014 expansion states, and in late expansion states, respectively.

"The study suggests that Medicaid expansion was highly effective in doing what it was supposed to do -- breaking down barriers to care," a coauthor said in a statement.

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