Disparities in receipt of a laparoscopic operation for ectopic pregnancy among TRICARE beneficiaries

Anju Ranjit*, Muhammad Ali Chaudhary, Wei Jiang, Tiannan Zhan, Eric B. Schneider, Sarah L. Cohen, Sarah E. Little, Adil H. Haider, Julian N. Robinson, Catherine T. Witkop

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background Racial disparities in receipt of a laparoscopic operation for ectopic pregnancy are attributed to inequalities in access to care. This study sought to determine if racial disparities in laparoscopic operation for ectopic pregnancy exist among a universally insured population. Methods Using 2006–2010 TRICARE (insurance for members of the United States Armed Services and their dependents) data, patients who received a laparoscopic operation or laparotomy for ectopic pregnancy were stratified into direct/military or purchased/civilian system of care. Odds of receipt of a laparoscopic operation in each racial group were compared adjusting for patient demographics, system of care, and severity of ectopic pregnancy. Results Among 3,041 patients in the study sample, 1,878 (61.7%) received laparotomy and 1,163 (38.2%) received a laparoscopic operation within 30 days of diagnosis. Overall, 42.4% of white women received a laparoscopic operation compared with 33.1% of Asian women and 34.9% of black women (P < .001). On multivariable analysis, black women had a 33% lesser odds of receiving a laparoscopic operation (odds ratio: 0.67; confidence interval: 0.55–0.83) compared with white women. These disparities were absent within direct care (odds ratio: 0.93; confidence interval: 0.71–1.21) but were present within purchased care (odds ratio: 0.54; confidence interval: 0.40–0.73). Conclusion Racial minority patients are less likely to receive a laparoscopic operation for ectopic pregnancy despite universal insurance coverage within civilian/purchased care. Further work is warranted to better understand the factors other than insurance access that may contribute to racial disparities in selection of operative approach.

Original languageEnglish
Pages (from-to)1341-1347
Number of pages7
JournalSurgery
Volume161
Issue number5
DOIs
StatePublished - May 2017

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