title: Racial Disparities in Initial Presentation of Benign Thyroid Disease for Resection.
abstract: Racial disparities exist in thyroidectomy outcomes. One contributing factor may be the disease state upon presentation to a surgeon. Minorities with thyroid cancer present at a later disease stage and with larger tumors. This relationship has not been examined for benign thyroid disease. We sought to examine the association between race, referral patterns, and disease severity for benign thyroid conditions.
  
  
  
  We analyzed all patients receiving a thyroidectomy for benign disease in our institutional endocrine surgery registry. Patient demographics, disease history, disease severity, and postoperative outcomes were investigated. Univariate analysis compared black and white patients. Multivariable linear regression examined the relationship between race and time to surgical referral.
  
  
  
  Of the 1189 patients studied, the majority (86.0 %) were white. Black and white patients differed in median income and reason for referral. When compared with white patients, black patients more commonly presented with compressive symptoms (black: 45.0 % vs. white: 21.2 %, p < .01) and dysphagia (19.0 % vs. 10.1 %, p < .01), and after a longer disease duration [black: median 0 years (interquartile ratio, IQR, 0-5) vs. white: 0 years (IQR, 0-2)]. Blacks also had larger glands than white [median 71 grams (IQR, 33.5-155.3) vs. 24.3 grams (IQR, 15.0-50.2)]. With the exception of reintubation rate, there were no differences in postoperative outcomes.
  
  
  
  Black patients with benign thyroid conditions have a longer time to surgical referral and present for surgical evaluation with more severe disease than white patients. Identification of these disparities is the first step in eliminating differences in patient care.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. Lindsay.Kuo@uphs.upenn.edu.
authors.forename: Lindsay E
authors.initials: LE
authors.lastname: Kuo
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kristina D
authors.initials: KD
authors.lastname: Simmons
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Wachtel
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Salman
authors.initials: S
authors.lastname: Zaheer
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D044469:Racial Groups; D012017:Referral and Consultation; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000175:diagnosis / Q000208:ethnology* / Q000601:surgery; D013965:Thyroidectomy; D044465:White People / Q000706:statistics & numerical data*