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Racial disparity gaps for thyroid surgery, RAI decreasing
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Racial disparities in receiving appropriate surgical and radioactive iodine treatment in adults with differential thyroid cancer have decreased over time, study data show.
Sanziana A. Roman, MD, professor of surgery at Duke University, and colleagues evaluated data from the National Cancer Database (1998-2012) on 282,043 adults (80.3% white; 8.1% Hispanic; 7.2% black; 4.4% Asian) with differentiated thyroid cancer (DTC) to determine how racial/ethnic differences affect the appropriateness of surgery and radioactive iodine (RAI) treatment for DTC.
The likelihood of having medical insurance was lower among black (91.3%) and Hispanic participants (84.8%) compared with white (94.9%) and Asian participants (93%; P < .001).
Black participants had lower 5-year and 10-year overall survival rates compared with white participants (P < .001). Thirty-day readmission rates were highest among Hispanic participants (5.2%), followed by black (4.4%), Asian (3.8%) and white participants (3.6%; P < .001). Black participants had the highest 30-day and 90-day mortality rates.
Overall, 80% of participants underwent total thyroidectomy. Appropriate extent of thyroid surgery was more likely among white participants (93.1%) compared with black participants (90.7%; P < .001 in unadjusted analyses). The odds of receiving appropriate extent of thyroid surgery were lower among black participants compared with white participants after adjustment (OR = 0.78; 95% CI, 0.71-0.87).
Nearly half of all participants (47.8%) received RAI. Compared with white participants, the odds for receipt of appropriate RAI treatment were higher among black participants (OR = 1.07; 95% CI, 1.02-1.12) but lower among Hispanic participants (OR = 0.9; 95% CI, 0.86-0.95). RAI undertreatment was more likely among Hispanic (OR = 1.27; 95% CI, 1.18-1.36), black (OR = 1.26; 95% CI, 1.17-1.37) and Asian participants (OR = 1.25; 95% CI, 1.14-1.34) compared with white participants, whereas white participants were more likely to be overtreated with RAI compared with Hispanic (OR = 0.89; 95% CI, 0.84-0.94), black (OR = 0.83; 95% CI, 0.79-0.88) and Asian participants (OR = 0.79; 95% CI, 0.74-0.85).
The likelihood of receiving appropriate thyroid surgery increased at a rate of 5% per year from 1998 to 2012. The odds for undertreatment with RAI decreased by 3% per year, whereas the odds for overtreatment marginally increased.
“Our study demonstrates that appropriate utilization of thyroid surgery and RAI for DTC improved over the past 15 years for all racial groups,” the researchers wrote. “This finding is hopeful and suggests that awareness of guidelines has increased. Given that variation in practice implies variation in care, adherence to evidenced-based guidelines is important. In addition, with growing literature confirming racial disparities in health delivery, practitioners may have become more attuned to efforts to improve quality of care for all patients. ... Given the increasing trend in incidence of thyroid cancer and the substantial costs incurred in the longitudinal care of such patients, opportunity remains for clinicians, payers and policymakers to work together to standardize thyroid cancer care among vulnerable minority populations.” – by Amber Cox
Disclosure: Roman reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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