title: Sociodemographic disparities in differentiated thyroid cancer survival among adolescents and young adults in California.
abstract: BACKGROUND
  Few studies have focused on prognostic factors among adolescents and young adults (AYAs) 15 to 39 years of age when diagnosed with differentiated thyroid cancer (DTC). Our study expands upon prior work by including an evaluation of survival among AYA men and by neighborhood socioeconomic status, health insurance, and clinical factors to identify subgroups of young DTC patients at higher risk of mortality.
  
  
  METHODS
  Data for 16,827 AYA DTC patients diagnosed between 1988 and 2010 were obtained from the California Cancer Registry. Survival, through 2010, by sociodemographic and clinical factors was analyzed using Cox proportional hazards regression.
  
  
  RESULTS
  Of the 2.1% of AYAs who died, 16.7% died from thyroid cancer and 21.4% died from a subsequent cancer. In multivariate analyses, older AYAs 35 to 39 year of age (versus 15- to 29-year-olds), men (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.62-4.72), and AYAs of African American or Hispanic race/ethnicity (versus non-Hispanic whites) had worse thyroid cancer specific survival. In addition, residing in low socioeconomic status neighborhoods (HR 3.11 [CI 1.28-7.56]) and nonmetropolitan areas (HR 5.53 [CI 2.07-14.78]) was associated with worse thyroid cancer-specific survival among AYA men, but not AYA women.
  
  
  CONCLUSIONS
  Despite the generally good prognosis among AYAs with DTC, we identified subgroups of AYA patients at risk for poor outcomes. Further study of the factors underlying these associations, including possible barriers to receiving high-quality treatment and follow-up care, as well as lifestyle factors, are critical to reducing these disparities.
authors.affiliation: 1Cancer Prevention Institute of California, Fremont, California.|2Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: 3Endocrine Surgery Research Program, Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago Illinois.
authors.forename: Raymon H
authors.initials: RH
authors.lastname: Grogan
authors.affiliation: 4Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.affiliation: 1Cancer Prevention Institute of California, Fremont, California.
authors.forename: Li
authors.initials: L
authors.lastname: Tao
authors.affiliation: 3Endocrine Surgery Research Program, Department of Surgery, University of Chicago, Pritzker School of Medicine, Chicago Illinois.
authors.forename: Michael G
authors.initials: MG
authors.lastname: White
authors.affiliation: 5Department of Pediatrics, University of Chicago, Chicago, Illinois.
authors.forename: Kenan
authors.initials: K
authors.lastname: Onel
authors.affiliation: 1Cancer Prevention Institute of California, Fremont, California.|2Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Horn-Ross
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002140:California; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D012111:Residence Characteristics; D012424:Rural Population; D012923:Social Class; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult