Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Clin Endocrinol (Oxf). 2021 Jun;94(6):1025-1034. doi: 10.1111/cen.14429. Epub 2021 Feb 7.
The incidence of hypothyroidism is not expected to differ by socioeconomic factors. However, the decision to test and initiate treatment may differ. We aimed to examine whether educational level influences the probability of thyroid stimulation hormone (TSH)-measurement and initiation of levothyroxine treatment.
Citizens in the greater Copenhagen Area during 2001-2015 were included. Individual-level data on educational level, diagnoses, GP-contact, TSH-measurement and medication were derived from administrative and healthcare registers. The relative risks (RR) between educational levels of annual TSH-measurement and treatment initiation following a TSH-measurement were analysed in Poisson regression models with generalized estimation equations.
A TSH-measurement was performed in 19% of 9,390,052 person years. The probability of TSH-measurement was higher with short (RR 1.16 [95% CI 1.15-1.16]) and medium (RR 1.11 [95% CI 1.06-1.12]) compared with long education. Treatment was initiated after 0.8% of 2,049,888 TSH-measurements. For TSH < 5 mIU/L, RR for treatment initiation ranged between 0.47 (95%CI 0.39-0.57) and 0.78 (95%CI 0.67-0.91) for short and medium compared with long education. For TSH 5-10 mIU/L, there was no statistically significant difference. For TSH > 10 mIU/L, RR was 1.07 (95% CI 1.02-1.12) for short and 1.08 (95% CI 1.03-1.13) for medium compared with long education.
The probability of TSH-measurement was higher with shorter education, and the probability of treatment initiation with TSH > 10 mIU/L was marginally higher with short-medium education compared with long education. However, the probability of treatment initiation with TSH < 5 mIU/L, that is treatment incongruous with guidelines, was substantially higher in persons with long education.
甲状腺功能减退症的发病率预计不受社会经济因素的影响。然而，检测和开始治疗的决定可能会有所不同。我们旨在研究教育水平是否会影响促甲状腺激素（TSH）检测和左旋甲状腺素治疗的启动概率。
纳入 2001 年至 2015 年大哥本哈根地区的居民。个体层面的教育水平、诊断、全科医生就诊、TSH 检测和药物使用数据来自行政和医疗登记处。采用广义估计方程的泊松回归模型分析 TSH 检测的年度相对风险（RR）和 TSH 检测后的治疗启动。
939 万零 252 人年中进行了 TSH 检测，占 19%。与长期教育相比，短期（RR 1.16[95%CI 1.15-1.16]）和中期（RR 1.11[95%CI 1.06-1.12]）教育的 TSH 检测概率更高。在 204 万 988 次 TSH 检测后，开始进行治疗。对于 TSH<5 mIU/L，与长期教育相比，短期和中期治疗启动的 RR 范围在 0.47（95%CI 0.39-0.57）至 0.78（95%CI 0.67-0.91）之间。对于 TSH 5-10 mIU/L，无统计学显著差异。对于 TSH>10 mIU/L，短期教育的 RR 为 1.07（95%CI 1.02-1.12），中期教育的 RR 为 1.08（95%CI 1.03-1.13），与长期教育相比。
与长期教育相比，短期教育的 TSH 检测概率更高，而 TSH>10 mIU/L 的治疗启动概率与短期-中期教育相比略高。然而，长期教育的 TSH<5 mIU/L 治疗启动概率，即与指南不一致的治疗，显著更高。
