Effects of socioeconomic status on children with well-differentiated thyroid cancer

• Type of Material: Article
• Authors: EF Garner, University of Alabama; II Maizlin, University of Alabama; MB Dellinger, Seattle Children’s Hospital; KW Gow, Seattle Children’s Hospital; M Goldfarb, Providence St. John’s Health Center; AB Goldin, Seattle Children’s Hospital; JJ Doski, University of Texas; M Langer, Tufts University; JG Nuchtern, Texas Children’s Hospital; SA Vasudevan, Texas Children’s Hospital; Mehul V. Raval, Emory University; EA Beierle, University of Alabama
• Language: English
• Date: 2017-09-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.surg.2017.04.008
• Title of Journal or Parent Work: Surgery
• ISSN: 0039-6060
• Volume: 162
• Issue: 3
• Start Page: 662
• End Page: 669
• Grant/Funding Information: This work was supported in part by NIH T32 CA091078 (EFG, salary support).
• Keywords: RADIOACTIVE IODINE; PARATHYROID SURGERY; CARCINOMA; Science & Technology; ECONOMIC OUTCOMES; DISPARITIES; Surgery; Life Sciences & Biomedicine; CARE
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood. Methods Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable. Results A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment (P <.002). Similarly, uninsured children had a longer time from diagnosis to treatment (28 days) compared with those with government (19 days) or private (18 days) insurance (P <.001). Despite being diagnosed at a higher stage and having a longer time interval between diagnosis and treatment, there was no significant difference in either overall survival or rates of unplanned readmissions based on any of the socioeconomic surrogate variables. Conclusion Children from lower income families and those lacking insurance experienced a longer period from diagnosis to treatment of their well-differentiated thyroid cancer remains. These patients also presented with higher stage disease. These data suggest a delay in care for children from low-income families. Although these findings did not translate into worse outcomes for well-differentiated thyroid cancer remains, future efforts should focus on reducing these differences.