Inequities in Thyroid Cancer Care: Populations Most at Risk for Delays in Diagnosis and Treatment

Background: Delays in treatment for thyroid cancer have been associated with higher overall mortality rates. However, few studies have explored the impact of health disparities on delayed presentation and treatment for thyroid cancer. This study aims to investigate what patient sociodemographic factors contribute to delays in presentation and treatment of thyroid cancer. Methods: Using the National Cancer Database, we identified patients diagnosed with well-differentiated thyroid cancer between 2004 and 2016 who underwent thyroidectomy. Multivariable regression analyses were conducted to examine the impact of race, insurance status, income, and distance from treatment facility on time to surgical treatment, stage, the presence of distant metastases, and tumor size. Results: We identified 89,105 patients diagnosed with well-differentiated thyroid cancer who underwent thyroidectomy. Non-white patients who were uninsured or had Medicare or Medicaid insurance were more likely to experience delays in care, present with higher stages at diagnosis, and have distant metastases and larger tumors at presentation. Distance from treatment facility was associated with delays in surgical treatment and higher stage at presentation. Conclusion: Delays in thyroid cancer presentation and surgical treatment vary by race, insurance status, and patient location. Health care policies should focus on targeting at-risk individuals to reduce health care disparities in this disease.