Racial and socioeconomic disparities in presentation and outcomes of well-differentiated thyroid cancer.
BACKGROUND
Racial/ethnic minorities suffer disproportionate morbidity and mortality from chronic diseases.


OBJECTIVE
Our objective was to assess racial and socioeconomic status (SES) disparities in well-differentiated thyroid cancer (WDTC) patients.


METHODS
We conducted a retrospective cohort study on 25 945 patients with WDTC (1999-2008) from the California Cancer Registry (57% white, 4% black, 24% Hispanic, and 15% Asian-Pacific Islander [API]).


RESULTS
We evaluated effect of race and SES variables on stage of cancer presentation and overall/disease-specific survival.


RESULTS
Significant differences in stage of presentation between all racial groups were found (P<.001), with minority groups presenting with a higher percentage of metastatic disease as compared with white patients (black, odds ratio [OR]=1.36 with confidence interval [CI] 1.01-1.84; Hispanic, OR=1.89 [CI, 1.62-2.21], API, OR=1.82 [CI, 1.54-2.15]). Hispanic (OR=1.59, [CI, 1.48-1.72]) and API (OR=1.32 [1.22-1.44]) patients also presented with higher odds of regional disease. Patients with the lowest SES presented with metastatic disease more often than those with the highest SES (OR=1.45 [CI, 1.16-1.82]). Those that were poor/uninsured and/or with Medicaid insurance had higher odds of presenting with metastatic disease as compared with those with private insurance (OR=2.41, [CI, 2.10-2.77]). Unadjusted overall survival rates were higher among API and Hispanic patients and lower among black patients (P<.001 vs white patients). Adjusted overall survival also showed a survival disadvantage for black patients (hazard ratio=1.4, [CI, 1.10-1.73]) and survival advantage for API patients (hazard ratio=0.83, [CI, 0.71-0.97]). In disease-specific survival analyses, when only those patients with metastatic disease were analyzed separately, black patients again had the lowest survival rates, and Hispanic/API patients had the highest survival rates (P<.04).


CONCLUSIONS
Black patients and those with low SES have worse outcomes for thyroid cancer. API and Hispanic patients may have a protective effect on survival despite presenting with more advanced disease.
University of California, Los Angeles, Section of Endocrine Surgery (A.H., M.W.Y.) and Department of Biomathematics (N.L.), Los Angeles, California 90095.
Avital
A
Harari
Ning
N
Li
Michael W
MW
Yeh
D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality