Award Date

5-1-2019

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Environmental and Occupational Health

First Committee Member

Sheniz Moonie

Second Committee Member

Chad Cross

Third Committee Member

Brian Labus

Fourth Committee Member

Jessica Word

Number of Pages

74

Abstract

Background: In the United States, female breast cancer was the leading cause of new cancer cases from 2011-2015. Since the Women’s Health and Cancer Act of 1998 (WHCRA), the federal government mandates employee and private health insurance providers to cover breast reconstruction if they cover mastectomies. Postmastectomy breast reconstruction (PBR) rates increased after the WHCRA, but these rates have remained relatively low throughout recent years. Objective: The objective of this study was to determine factors associated with women having PBR due to breast cancer in Nevada and the United States from 2008 to 2013. Methods: Using two HCUP database, NIS and SID databases, this study used complex multiple logistic regression and binary logistic regression to analyze the association between PBR and specific demographic, payer type, and hospital characteristics in the United States and Nevada. Weighted frequencies were calculated for the different breast reconstruction procedures and comorbidities that this study utilizes. Results: The results demonstrated that women who were younger, non-African American, had private health insurance, were in the high-income status category, and received care at an urban teaching hospital had higher odds of having PBR than other women. In Nevada and the United States, surgeons performed tissue expander insertions more than any other breast reconstruction procedure. The same nine comorbidities were prevalent among women in the United States and Nevada. Conclusion: Disparities among age, payer types, racial/ethnic groups, and socioeconomic status in PBR still exist in the United States. Nevada should consider implementing breast reconstruction education policies to decrease these disparities and policy makers should ensure that federally mandated education is available in multiple languages, as well as, representative of all of cultures.

Keywords

Breast; HCUP; Immediate; Nevada; Postmastectomy; Reconstruction

Disciplines

Biostatistics | Epidemiology

Language

English


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