Effect of social determinants of health care on outcomes for well-differentiated thyroid cancer at an urban safety-net hospital.

Abstract

Introduction: There are multiple studies reporting the impact of social determinants of health on survival of well differentiated thyroid cancer. Many studies utilized national databases, but few have examined the effect at an institutional level. We hypothesized that assessing survival at our urban safety-net hospital would identify disparities among gender, race, and insurance status.

Methods: We examined records from our institutional cancer registry for patients diagnosed with thyroid cancer from 2000 to 2023. We obtained data regarding their demographics and cancer stage at diagnosis. A survival analysis was performed using Kaplan-Meier estimates and Cox proportional hazards regression models.

Results: A total of 336 patients were diagnosed during this time. Most patients were female 285 (84%) and 215 (63%) under age 55. We compared survival among our White 155 (54%) and Black populations 127 (45%). Insurance status was stratified into non-insured/VA insurance/other 116 (34%), Medicaid 107 (32%), private insurance 64 (19%), and Medicare 49 (15%). Five-year survival was worse in those age > 55 (p < .001), White individuals (p=.019), and Medicaid beneficiaries (p=.003). Mortality risk was higher in males (p=.012, confidence interval (CI): 0.13-0.78), age > 55 (p<.001, CI: 0.13-0.78), Whites (p=.026, CI: 0.21-0.91), and Medicaid insured (p=.002, CI: 0.08-0.56).

Conclusions: Our study demonstrates there are significant factors associated with disparities in survival for thyroid cancer. Interestingly, our White population is at increased risk which is contrary to other studies at either a national or institutional level. Further investigation is required to identify how to target this group to alleviate any modifiable factors impacting outcomes.