This article is more than 5 years old. Information may no longer be current.
Thyrotoxicosis hospitalization vs. outpatient treatment more likely for adults without health insurance
Among adults with thyrotoxicosis and associated complications, risk for hospitalization is higher among those without health insurance and lower for those with higher education and higher median income, according to findings published in Thyroid.
“Several studies have been conducted to try to determine factors that could allow the clinician to identify those patients who are at higher risk of developing complicated thyrotoxicosis or thyroid storm,” Ana Marcella Rivas, MD, an assistant professor in the department of internal medicine at the Texas Tech University Sciences Center in Lubbock, and colleagues wrote. “The role of socioeconomic factors in the development of complicated thyrotoxicosis is hardly mentioned in the thyroid literature, and, to our knowledge, no measures have been implemented by health care policymakers to address this in the United States.”
Rivas and colleagues examined data from a retrospective chart review of adults admitted with hyperthyroidism or thyrotoxicosis between 2011 and 2017 to University Medical Center, a public hospital in Lubbock, Texas, where “unusually high” thyrotoxicosis-related admissions were reported. More specifically, during the review period, admissions for thyrotoxicosis made up 0.05% of all admissions. The researchers noted that such a rate was five times greater than the rate reported in a nationwide survey in Japan, where universal health care insurance is offered.
During the review, participants were divided into groups based on whether they received care in the hospital (n = 80; mean age, 43.7 years; 66.3% women) or in an outpatient setting (n = 210; mean age, 44.2 years; 79.6% women).
The researchers found that adults with no health insurance had higher odds of hospitalization vs. outpatient treatment for complicated thyrotoxicosis (OR = 9.32; 95% CI, 3.74-23.2). Thirty-one percent of those in the hospitalized group had commercial insurance or Medicare coverage vs. 72% in the outpatient group. In addition, lower weight (mean, 73.9 kg vs. 79.4 kg), lower BMI (mean, 26.5 kg/m2 vs. 29.1 kg/m2) and higher heart rate (mean, 124 bpm vs. 87.3 bpm) were noted in the hospitalized group compared with the outpatient group.
In addition, participants with higher education (OR = 0.38; 95% CI, 0.18-0.8) and higher median income (OR = 0.75; 95% CI, 0.57-0.99) were less likely to be hospitalized for thyrotoxicosis than to receive outpatient treatment. Median income was determined based on the 2016 inflation-adjusted median income of a participant’s ZIP code as reported by the U.S. Census Bureau. Participants with Hispanic/Latino ethnicity were also less likely to be hospitalized (OR = 0.29; 95% CI, 0.14-0.59).
“Access to health care and education are factors that should be targeted as we attempt to improve the health of our population and decrease health care costs,” the researchers wrote. “As we recognize unfavorable socioeconomic conditions as a risk factor for poor outcome for thyrotoxic patients, the effectiveness and success of different treatment modalities available for thyrotoxicosis should be re-evaluated accounting for socioeconomic factors to allow us to make better treatment decisions on these patients.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.