Hispanic and Asian adults with thyroid cancer have lower risk for death than white adults
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Key takeaways:
- Asian and Hispanic adults with thyroid cancer are more likely to have advanced disease than white adults.
- Black adults with thyroid cancer have a higher risk for death than white adults.
Hispanic and Asian adults diagnosed with thyroid cancer are more likely to have advanced disease, but also have better survival outcomes, compared with white adults, according to study data.
In findings published in the Journal of Surgical Research, researchers found some socioeconomic factors were associated with having a more advanced stage of thyroid cancer and death. When race and ethnicity were analyzed, Asian and Hispanic adults had better survival outcomes than white adults, and Black adults had worse survival outcomes than white participants.
“We found certain socioeconomic factors were associated with a worse clinical outcome of thyroid cancer,” Herbert Chen, MD, chair of the department of surgery at the University of Alabama at Birmingham (UAB) Heersink School of Medicine, and Rongzhi Wang, MD, general surgery resident in the department of surgery at the UAB Heersink School of Medicine, told Healio. “Physicians should monitor patients with these socioeconomic factors more closely to reduce the health disparity in thyroid cancer.”
Chen, Wang and colleagues collected data from the National Cancer Database of adults in the U.S. diagnosed with well-differentiated thyroid cancer between 2004 and 2018. Researchers collected data on distance from home to the health care clinic of diagnosis, household income, insurance status, and race and ethnicity. The racial-ethnic categories included in the study were white, Black, Asian and Hispanic. Adults with a stage I or II tumor were considered to have early-stage disease, whereas stage III and IV thyroid cancer was defined as advanced disease.
There were 322,923 adults with thyroid cancer included in the study, of whom 78.2% were white, 7.1% were Black, 5.2% were Asian and 9.1% were Hispanic.
Advanced disease more common in men, Hispanic and Asian adults
In multivariate adjusted analysis, adults younger than 50 years (adjusted OR = 0.22; 95% CI, 0.21-0.22; P < .001), those living in a home with a lower household income (aOR = 0.98; 95% CI, 0.96-0.99; P < .001), adults with no comorbidities (aOR = 0.9; 95% CI, 0.88-0.92; P < .001) and those living less than 28.9 miles from the clinic they were diagnosed (aOR = 0.89; 95% CI, 0.87-0.91; P < .001) had a lower likelihood of having advanced disease. Men (aOR = 1.96; 95% CI, 1.92-1.99; P < .001) were more likely to have advanced disease than women, and adults with no health insurance (aOR = 1.39; 95% CI, 1.31-1.47; P < .001) were more likely to have advanced disease than people with insurance.
Black adults had similar odds for an advanced disease diagnosis as white adults, whereas Hispanic adults (aOR = 1.49; 95% CI, 1.45-1.54; P < .001) and Asian adults (aOR = 1.49; 95% CI, 1.43-1.55; P < .001) were more likely to be diagnosed with advanced disease. In the survival analysis, Asian adults (HR = 0.77; P < .001) and Hispanic adults (HR = 0.82; P < .001) were less likely to die of thyroid cancer than white adults, whereas Black adults had a higher risk for death (HR = 1.27; P < .001).
“It was not surprising to see a greater overall survival in the Hispanic and Asian patient population,” Chen and Wang said. “The white patient population had the highest rate of living far away from the hospital of diagnosis. Household and family support is another social factor influencing the clinical outcome. We speculate that the Hispanic and Asian patient population could have more social support than the white patient population.”
Lack of health insurance linked to worse survival outcomes
The risk for death from thyroid cancer was lower among adults living in a home with a median income of greater than $40,227 than those living in homes with a median income below $40,227. Adults living less than 28.9 miles from their place of diagnosis had a lower risk for death than those living more than 28.9 miles away from their diagnosis clinic (HR = 0.9; P < .001). The risk for death from thyroid cancer was lower for adults with private insurance (HR = 0.58; P < .001) and government insurance (HR = 0.95; P < .001) than those with no insurance.
“We have identified the demographic factors that influenced the clinical outcome of thyroid cancer,” Chen and Wang said. “Further qualitative studies to investigate the barriers to thyroid cancer care among patients with these demographic factors would be meaningful.”
For more information:
Herbert Chen, MD, FACS, can be reached at hchen@uabmc.edu.
Rongzhi Wang, MD, can be reached at rongzhiwang@uabmc.edu.
Perspective
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These study results, which are based on a large cohort of 322,923 patients with well-differentiated thyroid cancer from the National Cancer Database, are interesting and illustrate the significant impact of nonclinical factors, such as income and insurance status, on survival from thyroid cancer. The finding that Asian and Hispanic patients and patients without insurance are more likely to be diagnosed with more advanced thyroid cancer is consistent with prior smaller studies.
Disparities exist in access to and delivery of thyroid cancer care in the U.S., with vulnerable patient populations, including Black patients and patients without insurance, at risk for worse survival. These findings emphasize the need for changes in public policy to make insurance coverage more accessible and affordable for Americans, and for more funding for thyroid cancer disparities research.
Limitations of this study include the aggregation of racial-ethnic subgroups, which can mask disparities in thyroid cancer outcomes. For example, the Asian race category is a heterogenous group composed of many distinct ethnic subgroups that represents a wide range of socioeconomic statuses. Thus, while the study finding of a survival advantage for Asian patients may be true for some Asian subgroups, it may not be true for all Asian subgroups. Furthermore, with prior studies consistently demonstrating the importance of surgeon volume on thyroid cancer patient outcomes, more granular data are needed to understand the association between a shorter distance (less than 28.9 miles) between a patient’s residence to the hospital of diagnosis and improved survival.
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