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Racial, socioeconomic differences influenced thyroid cancer outcomes
Racial and socioeconomic imbalances may affect the presentation and outcomes of patients with well-differentiated thyroid cancer, according to results of a retrospective cohort study.
Researchers evaluated 25,945 patients with well-differentiated thyroid cancer who were entered in the California Cancer Registry between 1999 and 2008. Racial groups identified for analysis included non-Hispanic white, non-Hispanic black, Hispanic and Asian/Pacific Islander. Disease staging was classified as localized, regional and remote/metastatic.
The researchers categorized health insurance coverage as private, poor/uninsured or government/military. The Kaplan-Meier method was used to approximate OS within each race, and the log-rank test was utilized to compare the curves across race groups.
The researchers found that significant disparities existed between all race groups (P<.001). Minority groups exhibited a higher percentage of metastatic disease upon presentation than white patients (OR=1.36; 95% CI, 1.01-184 for black patients; OR=1.89; 95% CI, 162-2.21 for Hispanic patients; OR=1.82; 95% CI, 1.54-2.15 for Asian/Pacific Islander patients). Hispanics (OR=1.59; 95% CI, 1.47-1.72) and Asian/Pacific Islanders (OR=1.32; 95% CI, 1.22-1.44) also were more likely to present with regional disease.
Patients with the lowest socioeconomic status were more likely to present with metastatic disease than those with the highest socioeconomic status (OR=1.45; 95% CI, 1.16-1.82). Patients in the poor/uninsured category and those enrolled in Medicaid were more likely than patients with private insurance to present with metastases (OR=2.41; 95% CI, 2.1-2.77). Asian/Pacific Islander and Hispanic patients had higher adjusted OS rates, whereas black patients had lower adjusted survival rates (P<.001 vs. white patients). The adjusted OS calculations also revealed a survival disadvantage for black patients (HR=1.4; 95% CI, 1.1-1.73) and a survival advantage for Asian/Pacific Islander patients (HR=0.83; 95% CI, 0.71-0.87).
A disease-specific survival calculation, which analyzed only those with metastatic disease, showed that black patients had the lowest survival rates, whereas Hispanic and Asian/Pacific Islander patients demonstrated the highest survival rates (P<.04).
The researchers theorized that differences in tumor biology and genetic variance might account for the apparent survival advantage experienced by Hispanic and Asian/Pacific Islander patients.
Differences in thyroid cancer outcomes might also be the result of clinician bias, the investigators said.
“Substantial evidence indicates that disparities in health status in the United States result largely from longstanding pervasive racial and ethnic discrimination, which can manifest by offering dissimilar diagnostic procedures and/or therapies for the same disease process,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.