title: Primary hyperparathyroidism in the underinsured: a study of 493 patients.
abstract: BACKGROUND
  Disparities may exist in the care of patients with primary hyperparathyroidism (HPT). This study examines the presentation and outcomes of underinsured patients undergoing parathyroidectomy.
  
  
  METHODS
  We divided 493 HPT patients who underwent initial parathyroidectomy from 2000 to 2008 at a single institution into 2 groups: underinsured patients (group 1; n = 94) evaluated and treated at a county hospital, and patients with insurance (group 2; n = 399). Univariate and multivariate analysis adjusting for race and ethnicity were conducted to determine the association of being underinsured with several clinical variables.
  
  
  RESULTS
  More patients in group 1 compared with group 2 were of black or Hispanic background (92% vs. 44%; P < .0001). Group 1 patients had higher mean preoperative serum calcium and PTH levels: 12.1 vs. 11.8 mg/dL (P = .009) and 263 vs. 198 pg/mL (P = .03), respectively. Seven group 1 (7.4%) and 7 group 2 (1.8%) patients presented with hypercalcemic crisis (P = .003). On multivariate analysis, underinsurance was associated with higher serum calcium levels (P = .011) and hypercalcemic crisis at presentation (odds ratio, 5.59; 95% confidence interval, 1.45-21.51; P = .012). Follow-up was shorter in group 1 patients (15 vs. 24 months; P < .001) and postoperative PTH levels were higher (76 vs. 48 pg/mL; P < .001). Other perioperative data were not different between the groups.
  
  
  CONCLUSIONS
  Underinsured patients with HPT may present with higher serum calcium and PTH levels, are more likely to have hypercalcemic crisis, and less likely to return for follow-up. Underfunded health insurance coverage may account for differences seen in this study.
authors: Division of Endocrine Surgery, University of Miami, Miami, FL, USA.
authors: Azad A
authors: AA
authors: Jabiev
authors: John I
authors: JI
authors: Lew
authors: Jane L
authors: JL
authors: Garb
authors: Yamile M
authors: YM
authors: Sanchez
authors: Carmen C
authors: CC
authors: Solorzano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium