Effects of socioeconomic status on children with well-differentiated thyroid cancer
Background Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid canc...
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| Veröffentlicht in: | Surgery 2017-09, Vol.162 (3), p.662-669 |
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| creator | Garner, Evan F., MD Maizlin, Ilan I., MD Dellinger, Matthew B., MD Gow, Kenneth W., MD Goldfarb, Melanie, MD, MS Goldin, Adam B., MD, MPH Doski, John J., MD Langer, Monica, MD Nuchtern, Jed G., MD Vasudevan, Sanjeev A., MD Raval, Mehul V., MD Beierle, Elizabeth A., MD |
| description | Background Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood. Methods Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable. Results A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment ( P |
| doi_str_mv | 10.1016/j.surg.2017.04.008 |
| format | Article |
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Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood. Methods Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable. Results A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment ( P < .002). Similarly, uninsured children had a longer time from diagnosis to treatment (28 days) compared with those with government (19 days) or private (18 days) insurance ( P < .001). Despite being diagnosed at a higher stage and having a longer time interval between diagnosis and treatment, there was no significant difference in either overall survival or rates of unplanned readmissions based on any of the socioeconomic surrogate variables. Conclusion Children from lower income families and those lacking insurance experienced a longer period from diagnosis to treatment of their well-differentiated thyroid cancer remains. These patients also presented with higher stage disease. These data suggest a delay in care for children from low-income families. Although these findings did not translate into worse outcomes for well-differentiated thyroid cancer remains, future efforts should focus on reducing these differences.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2017.04.008</identifier><identifier>PMID: 28602495</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Child ; Cohort Studies ; Databases, Factual ; Disease-Free Survival ; Female ; Healthcare Disparities - statistics & numerical data ; Humans ; Insurance Coverage - economics ; Insurance Coverage - statistics & numerical data ; Kaplan-Meier Estimate ; Male ; Medically Uninsured - statistics & numerical data ; Needs Assessment ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Retrospective Studies ; Risk Assessment ; Socioeconomic Factors ; Surgery ; Survival Analysis ; Thyroid Neoplasms - mortality ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - surgery ; Thyroidectomy - economics ; Thyroidectomy - ethics ; Thyroidectomy - methods ; Treatment Outcome ; United States</subject><ispartof>Surgery, 2017-09, Vol.162 (3), p.662-669</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c510t-1c17988056bad3cac70b59176648625917206af1fc3f3c63a2d784eee1099deb3</citedby><cites>FETCH-LOGICAL-c510t-1c17988056bad3cac70b59176648625917206af1fc3f3c63a2d784eee1099deb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0039606017303070$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28602495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garner, Evan F., MD</creatorcontrib><creatorcontrib>Maizlin, Ilan I., MD</creatorcontrib><creatorcontrib>Dellinger, Matthew B., MD</creatorcontrib><creatorcontrib>Gow, Kenneth W., MD</creatorcontrib><creatorcontrib>Goldfarb, Melanie, MD, MS</creatorcontrib><creatorcontrib>Goldin, Adam B., MD, MPH</creatorcontrib><creatorcontrib>Doski, John J., MD</creatorcontrib><creatorcontrib>Langer, Monica, MD</creatorcontrib><creatorcontrib>Nuchtern, Jed G., MD</creatorcontrib><creatorcontrib>Vasudevan, Sanjeev A., MD</creatorcontrib><creatorcontrib>Raval, Mehul V., MD</creatorcontrib><creatorcontrib>Beierle, Elizabeth A., MD</creatorcontrib><title>Effects of socioeconomic status on children with well-differentiated thyroid cancer</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood. Methods Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable. Results A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment ( P < .002). Similarly, uninsured children had a longer time from diagnosis to treatment (28 days) compared with those with government (19 days) or private (18 days) insurance ( P < .001). Despite being diagnosed at a higher stage and having a longer time interval between diagnosis and treatment, there was no significant difference in either overall survival or rates of unplanned readmissions based on any of the socioeconomic surrogate variables. Conclusion Children from lower income families and those lacking insurance experienced a longer period from diagnosis to treatment of their well-differentiated thyroid cancer remains. These patients also presented with higher stage disease. These data suggest a delay in care for children from low-income families. Although these findings did not translate into worse outcomes for well-differentiated thyroid cancer remains, future efforts should focus on reducing these differences.</description><subject>Adolescent</subject><subject>Child</subject><subject>Cohort Studies</subject><subject>Databases, Factual</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Humans</subject><subject>Insurance Coverage - economics</subject><subject>Insurance Coverage - statistics & numerical data</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medically Uninsured - statistics & numerical data</subject><subject>Needs Assessment</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Socioeconomic Factors</subject><subject>Surgery</subject><subject>Survival Analysis</subject><subject>Thyroid Neoplasms - mortality</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Thyroidectomy - economics</subject><subject>Thyroidectomy - ethics</subject><subject>Thyroidectomy - methods</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UsFu1DAQtRCILoUf4IBy5JLtOE7sREKVUFWgUiUOhfPIO550vWTjYiet9u9xtKUCDpxsjd97M35vhHgrYS1B6rPdOs3xdl2BNGuo1wDtM7GSjapKo7R8LlYAqis1aDgRr1LaAUBXy_alOKlaDVXdNStxc9n3TFMqQl-kQD4whTHsPRVpstOc62NBWz-4yGPx4Kdt8cDDUDqfabk0eTuxK6btIQbvCrIjcXwtXvR2SPzm8TwV3z9dfrv4Ul5__Xx18fG6pEbCVEqSpmtbaPTGOkWWDGyaThqt61ZXy60CbXvZk-oVaWUrZ9qamSV0neONOhXnR927ebNnR3mcaAe8i35v4wGD9fj3y-i3eBvusWmaOotngfePAjH8nDlNuPeJ8v_syGFOKDtoTWca02ZodYRSDClF7p_aSMAlDdzhkgYuaSDUmNPIpHd_DvhE-W1_Bnw4AjjbdO85YiLP2UPnY04FXfD_1z__h06DHz3Z4QcfOO3CHMccAEpMFQLeLPuwrIM0ChQYUL8AEYmyVg</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Garner, Evan F., MD</creator><creator>Maizlin, Ilan I., MD</creator><creator>Dellinger, Matthew B., MD</creator><creator>Gow, Kenneth W., MD</creator><creator>Goldfarb, Melanie, MD, MS</creator><creator>Goldin, Adam B., MD, MPH</creator><creator>Doski, John J., MD</creator><creator>Langer, Monica, MD</creator><creator>Nuchtern, Jed G., MD</creator><creator>Vasudevan, Sanjeev A., MD</creator><creator>Raval, Mehul V., MD</creator><creator>Beierle, Elizabeth A., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170901</creationdate><title>Effects of socioeconomic status on children with well-differentiated thyroid cancer</title><author>Garner, Evan F., MD ; Maizlin, Ilan I., MD ; Dellinger, Matthew B., MD ; Gow, Kenneth W., MD ; Goldfarb, Melanie, MD, MS ; Goldin, Adam B., MD, MPH ; Doski, John J., MD ; Langer, Monica, MD ; Nuchtern, Jed G., MD ; Vasudevan, Sanjeev A., MD ; Raval, Mehul V., MD ; Beierle, Elizabeth A., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c510t-1c17988056bad3cac70b59176648625917206af1fc3f3c63a2d784eee1099deb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Cohort Studies</topic><topic>Databases, Factual</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Humans</topic><topic>Insurance Coverage - economics</topic><topic>Insurance Coverage - statistics & numerical data</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medically Uninsured - statistics & numerical data</topic><topic>Needs Assessment</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Socioeconomic Factors</topic><topic>Surgery</topic><topic>Survival Analysis</topic><topic>Thyroid Neoplasms - mortality</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Thyroidectomy - economics</topic><topic>Thyroidectomy - ethics</topic><topic>Thyroidectomy - methods</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garner, Evan F., MD</creatorcontrib><creatorcontrib>Maizlin, Ilan I., MD</creatorcontrib><creatorcontrib>Dellinger, Matthew B., MD</creatorcontrib><creatorcontrib>Gow, Kenneth W., MD</creatorcontrib><creatorcontrib>Goldfarb, Melanie, MD, MS</creatorcontrib><creatorcontrib>Goldin, Adam B., MD, MPH</creatorcontrib><creatorcontrib>Doski, John J., MD</creatorcontrib><creatorcontrib>Langer, Monica, MD</creatorcontrib><creatorcontrib>Nuchtern, Jed G., MD</creatorcontrib><creatorcontrib>Vasudevan, Sanjeev A., MD</creatorcontrib><creatorcontrib>Raval, Mehul V., MD</creatorcontrib><creatorcontrib>Beierle, Elizabeth A., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garner, Evan F., MD</au><au>Maizlin, Ilan I., MD</au><au>Dellinger, Matthew B., MD</au><au>Gow, Kenneth W., MD</au><au>Goldfarb, Melanie, MD, MS</au><au>Goldin, Adam B., MD, MPH</au><au>Doski, John J., MD</au><au>Langer, Monica, MD</au><au>Nuchtern, Jed G., MD</au><au>Vasudevan, Sanjeev A., MD</au><au>Raval, Mehul V., MD</au><au>Beierle, Elizabeth A., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of socioeconomic status on children with well-differentiated thyroid cancer</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>162</volume><issue>3</issue><spage>662</spage><epage>669</epage><pages>662-669</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood. Methods Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable. Results A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment ( P < .002). Similarly, uninsured children had a longer time from diagnosis to treatment (28 days) compared with those with government (19 days) or private (18 days) insurance ( P < .001). Despite being diagnosed at a higher stage and having a longer time interval between diagnosis and treatment, there was no significant difference in either overall survival or rates of unplanned readmissions based on any of the socioeconomic surrogate variables. Conclusion Children from lower income families and those lacking insurance experienced a longer period from diagnosis to treatment of their well-differentiated thyroid cancer remains. These patients also presented with higher stage disease. These data suggest a delay in care for children from low-income families. Although these findings did not translate into worse outcomes for well-differentiated thyroid cancer remains, future efforts should focus on reducing these differences.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28602495</pmid><doi>10.1016/j.surg.2017.04.008</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Child Cohort Studies Databases, Factual Disease-Free Survival Female Healthcare Disparities - statistics & numerical data Humans Insurance Coverage - economics Insurance Coverage - statistics & numerical data Kaplan-Meier Estimate Male Medically Uninsured - statistics & numerical data Needs Assessment Postoperative Complications - epidemiology Postoperative Complications - physiopathology Retrospective Studies Risk Assessment Socioeconomic Factors Surgery Survival Analysis Thyroid Neoplasms - mortality Thyroid Neoplasms - pathology Thyroid Neoplasms - surgery Thyroidectomy - economics Thyroidectomy - ethics Thyroidectomy - methods Treatment Outcome United States |
| title | Effects of socioeconomic status on children with well-differentiated thyroid cancer |
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