Disparity in the management of Graves' disease observed at an urban county hospital: a decade-long experience.
BACKGROUND
The objective of this study was to determine whether health care disparities exist in management of Graves' disease.


METHODS
Patients treated for Graves' disease from 1999 to 2009 were divided into medical and surgical treatment groups. A comparative analysis of age, sex, race, health insurance, and income was completed. Address and/or zip code were geocoded and median income was determined from census data.


RESULTS
A total of 634 patients were treated for Graves' disease; 535 (84%) medically and 99 (16%) surgically. Mean age (40 ± 15 vs 43 ± 11 y), percentage of women (84% vs 91%), and racial distribution were similar in the 2 groups (P > .05). In the surgical group, median income was lower ($31,530 vs $34,404; P = .07) and 52% of patients were uninsured compared with 30% of patients treated medically (P < .0001).


CONCLUSIONS
A disproportionate number of uninsured patients underwent thyroidectomy for Graves' disease. Social and economic factors may have a role in determining definitive therapy for Graves' disease.
Department of Surgery, Division of General Surgery, Case Western Reserve University School of Medicine, 2500 Metrohealth Dr., Cleveland, OH 44109, USA.
Judy
J
Jin
Victor
V
Sandoval
Mary E
ME
Lawless
Ashwini R
AR
Sehgal
Christopher R
CR
McHenry
D055011:Ablation Techniques; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013956:Antithyroid Agents / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006111:Graves Disease / Q000453:epidemiology / Q000628:therapy*; D054625:Healthcare Disparities; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy / Q000209:etiology; D007182:Income; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data; D057240:Patient Preference / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D016606:Thyroid Nodule / Q000453:epidemiology / Q000601:surgery; D013965:Thyroidectomy / Q000706:statistics & numerical data; D014505:Urban Population; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use; D055815:Young Adult
D013956:Antithyroid Agents; D017610:Calcium Compounds; D007457:Iodine Radioisotopes; D014815:Vitamins; D014807:Vitamin D