Session: OR32-Health Outcomes & Quality Improvement
Room 301 (Moscone Center)
Racial and ethnic minorities suffer disproportionate morbidity and mortality from chronic diseases, which may be attributable to disparities in access to care, lifestyles, and locally available resources. Here we investigate the effect of race and socioeconomic status (SES) on outcomes in well differentiated thyroid cancer (WDTC).
Patients with a new diagnosis of WDTC were abstracted from the California Cancer Registry (1999-2008). Racial groups were defined as Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian/Pacific Islander (API). Staging was defined as localized, regional, and remote (metastatic). The effect of race on stage of presentation was assessed by univariate and multivariable regression analyses (controlling for age, SES, sex, and insurance type). Kaplan Meir analysis was used to compare overall survival between races. Cumulative incidence functions were used for diseases specific survival analyses. Cox regression models were used to assess hazard ratios for affect of race on survival (adjusting for age, sex, stage, and comorbidities).
The study cohort comprised 25,945 patients with WDTC, including 14,802 White patients (57%); 939 non-hispanic Black patients (4%); 6,303 Hispanic patients (24%); and 3,901 Asian-Pacific Islander patients (15%). Significant differences in stage of presentation between all racial groups were found (p<0.0001), with minority groups presenting with a higher percentage of remote disease as compared to White patients (OR 1.36 Black, OR 1.89 Hispanic, OR 1.82 API, p<0.001). Hispanic (OR 1.59) and API (OR 1.32) patients presented with higher odds of regional disease than white patients (p<0.001). Patients with the lowest SES presented with remote disease more often than those with the highest SES (OR 1.45, P<0.001). Those that were poor/uninsured and/or with Medicaid insurance had higher odds of presenting with remote disease as compared to those with private insurance (OR 2.41, P<0.001). Unadjusted overall survival rates were higher among API And Hispanic patients and lower among Black patients (p<0.0001, -vs- White patients). Adjusted Cox regression analysis of overall survival showed a HR of 1.4 for Black patients, HR 0.86 for Asian patients, and no difference with Hispanic patients as compared to white patients (P<0.01). When only those patients with remote disease were analyzed separately, Black patients had the lowest disease specific survival rates, and Hispanic/API patients had the highest survival rates (P<0.04).
Racial and socioeconomic factors have a significant influence on the presentation and outcomes of WDTC. Further studies should look into how to better define and ameliorate these differences, which are likely multifactorial in origin.
Nothing to Disclose: AH, NL, MWY
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