Social Vulnerability and Time to Surgeon Evaluation for Primary Hyperparathyroidism in a Massachusetts Cohort

Identifying patients at risk for under-evaluation of primary hyperparathyroidism (PHPT) is essential to minimizing long-term sequelae including osteoporosis, nephrolithiasis, and cardiovascular disease. This study assessed the impact of social vulnerability on time to surgeon evaluation among patients with PHPT in a Massachusetts cohort. This is a retrospective review of patients from an institutional database with first incident hypercalcemia between 2010 and 2018 and subsequent biochemical diagnosis of PHPT. The overall social vulnerability index (SVI) and SVI subthemes were merged with the institutional data via patient zip code. Patients were stratified into SVI quartiles where quartile 4 (Q4) represented the highest vulnerability. Baseline sociodemographics and clinical characteristics were compared, and Cox-regression was used to assess the association between SVI and time to surgeon evaluation. Of 1,082 patients included, those with a higher SVI were less likely to be evaluated by a surgeon (Q1 SVI: 31.1% vs. Q2 SVI: 31.41% vs. Q3 SVI: 25.93% vs. Q4 SVI: 21.92%, p=0.03). On adjusted analysis, patients with the highest vulnerability had a 33% lower estimated rate of surgeon evaluation and were seen 67 days later compared to patients with the lowest vulnerability (HR: 0.67, CI 0.47-0.97, p=0.032). Differential rates of surgical evaluation by vulnerability persisted for the SVI subthemes for socioeconomic status, minority status and language, and housing type and transportation. Among a Massachusetts cohort, highly vulnerable populations with PHPT are at greater risk for under-evaluation by a surgeon which may contribute to the development of long term-sequelae of their disease.