title: Socioeconomic Factors Affect Outcomes in Well-Differentiated Thyroid Cancer.
abstract: OBJECTIVE
  The effects of socioeconomic status (SES) on the incidence of well-differentiated thyroid cancer (WDTC) are well researched. However, the association between SES and outcomes is not delineated. Our objective was to determine if SES affected outcomes of WDTC.
  
  
  METHODS
  Retrospective database review.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  The Henry Ford Virtual Data Warehouse Tumor Registry was used to identify cases of WDTC. Socioeconomic data were obtained through the 2010 US Census: median household income, percentage below poverty line, median household size, percentage rent versus own property, and general demographics. Survival was the primary outcome. Disease-specific survival was also calculated. Cox proportional hazards were calculated and a multivariate analysis performed.
  
  
  RESULTS
  There were 1317 patients with WDTC. In multivariable analysis, median household income (hazard ratio [HR]: 0.85, 95% confidence interval [95% CI]: 0.79-0.91), household size (HR: 1.49, 95% CI: 1.09-2.14), younger age (HR: 1.97, 95% CI: 1.74-2.23), and female sex (HR: 0.50, 95% CI: 0.37-0.69) were significantly associated with survival. Controlling for stage revealed percentage below poverty line (stage I, HR: 0.51, 95% CI: 1.34-1.78; stage IV, HR: 1.28, 95% CI: 1.04-1.57) and median household income (HR: 0.84, 95% CI: 0.71-0.99) to be significant factors in survival. Median household income was a statistically significant variable for disease-related death (HR: 0.82, 95% CI: 0.69-0.96) CONCLUSIONS: Along with effects on incidence, lower SES correlates with worse survival in WDTC. This suggests that a patient's economic background, with younger age and female sex, influences one's outcomes with regard to both overall and disease-specific death.
authors.affiliation: Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA wswegal1@hfhs.org.
authors.forename: Warren C
authors.initials: WC
authors.lastname: Swegal
authors.affiliation: Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Singer
authors.affiliation: Department of Biostatistics, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Peterson
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
authors.forename: Heather Spencer
authors.initials: HS
authors.lastname: Feigelson
authors.affiliation: Kaiser Permanente Colorado, Denver, Colorado, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Kono
authors.affiliation: Geisinger Center for Health Research, Danville, Pennsylvania, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Snyder
authors.affiliation: Kaiser Permanente Mid-Atlantic, Falls Church, Virginia, USA.
authors.forename: Thuy-Anh N
authors.initials: TA
authors.lastname: Melvin
authors.affiliation: Department of Head and Neck Surgical Oncology, Kaiser Permanente Southern California, San Diego, California, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Calzada
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
authors.forename: Nirupa R
authors.initials: NR
authors.lastname: Ghai
authors.affiliation: Essentia Institute of Rural Health, Duluth, Minnesota, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Saman
authors.affiliation: Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Chang
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology
keywords: median household income; socioeconomic status; well differentiated thyroid cancer