Division of Endocrine Surgery, Department of Surgery, Langone Medical Center, New York University, New York 10016, USA.
Thyroid. 2012 Mar;22(3):269-74. doi: 10.1089/thy.2010.0385. Epub 2012 Jan 10.
Healthcare disparities associated with insurance and socioeconomic status have been well characterized for several malignancies, such as lung cancer. To assess whether there are healthcare disparities in thyroid cancer, this study evaluated the stage on initial presentation of patients with differentiated thyroid cancer (DTC) in a public versus university teaching hospital.
A retrospective chart review was performed to identify patients with a new diagnosis of DTC from January 1, 2007, to January 1, 2010, in a large public and adjoining university teaching hospital at a single academic medical center. Medical records were reviewed for demographics, pathology, and American Joint Committee on Cancer tumor-node-metastasis stage at initial presentation.
There were 49 cases of well-DTC (96% papillary and 4% Hürthle) in the public hospital and 370 cases (95% papillary, 2% Hürthle, and 3% follicular) in the university teaching hospital. Median age (years) at presentation was 50 in the public versus 48 in the university teaching hospital (p=0.39). Ninety-six percent of public hospital patients were from ethnic minorities compared with 16% of university teaching hospital patients (p<0.0001). Only 1 (2%) public hospital patient had private insurance compared with 85% of university teaching hospital patients. Tumor status (p=0.002) and stage (p=0.03) were more advanced and extrathyroidal extension (p=0.02) was more prevalent among public hospital patients compared with university teaching hospital patients. In a multivariable analysis, public hospital, male gender, increasing age, advanced tumor status, and the presence of lymphovascular invasion were the best predictors of more advanced disease stage. Public hospital patients were 3.4 times more likely to present with advanced DTC than university teaching hospital patients of the same age, gender, tumor status, and lymphovascular invasion status (95% confidence interval 1.29-8.95).
In a public hospital, where the patient population is defined primarily by insurance status, patients were more likely to present with advanced-stage DTC than patients presenting to an adjacent university teaching hospital. These results suggest a disparity in the stage on initial presentation of DTC, possibly resulting in a delayed diagnosis of cancer.
医疗保险和社会经济地位与多种恶性肿瘤（如肺癌）相关的医疗保健差异已得到充分描述。为了评估甲状腺癌是否存在医疗保健差异，本研究评估了在一家公立医院和毗邻的大学教学医院中，分化型甲状腺癌（DTC）患者初始表现的分期。
对 2007 年 1 月 1 日至 2010 年 1 月 1 日期间在一家大型公立医院和毗邻的大学教学医院就诊的新诊断为 DTC 的患者进行了回顾性病历分析。记录了患者的人口统计学、病理学和美国癌症联合委员会肿瘤-淋巴结-转移分期的初始表现。
在公立医院有 49 例分化良好的甲状腺癌（96%为乳头状，4%为 Hurthle 型），在大学教学医院有 370 例（95%为乳头状，2%为 Hurthle 型，3%为滤泡状）。公立医院患者的中位年龄（岁）为 50 岁，而大学教学医院为 48 岁（p=0.39）。96%的公立医院患者来自少数民族，而大学教学医院的患者只有 16%来自少数民族（p<0.0001）。仅有 1 名（2%）公立医院患者拥有私人保险，而大学教学医院患者中有 85%拥有私人保险。与大学教学医院的患者相比，公立医院的患者肿瘤状态（p=0.002）和分期（p=0.03）更为晚期，甲状腺外侵犯更为常见（p=0.02）。在多变量分析中，公立医院、男性、年龄增长、肿瘤状态的进展以及血管淋巴管侵犯是疾病更晚期的最佳预测因素。在年龄、性别、肿瘤状态和血管淋巴管侵犯状态相同的情况下，公立医院患者患有晚期 DTC 的可能性是大学教学医院患者的 3.4 倍（95%置信区间 1.29-8.95）。
在一家以保险状况为主要特征的公立医院，患者更有可能表现为晚期 DTC，而不是在毗邻的大学教学医院就诊的患者。这些结果表明，DTC 的初始表现分期存在差异，这可能导致癌症的诊断延迟。
