原发性甲状旁腺功能亢进症患者甲状旁腺切除术利用的种族差异：来自 Medicare 索赔全国性分析的证据。
Racial disparities in the utilization of parathyroidectomy among patients with primary hyperparathyroidism: Evidence from a nationwide analysis of Medicare claims.
机构信息
Department of Surgery, Stanford University School of Medicine, Palo Alto, CA. Electronic address: https://twitter.com/AChanceToCut.
Stanford-Surgery Policy Improvement Research and Education Center (S-SPIRE), Department of Surgery, Stanford University School of Medicine, Palo Alto, CA; Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA.
出版信息
Surgery. 2022 Jan;171(1):8-16. doi: 10.1016/j.surg.2021.05.037. Epub 2021 Jul 3.
BACKGROUND
Among patients with primary hyperparathyroidism, parathyroidectomy offers a chance of cure and mitigation of disease-related complications. The impact of race/ethnicity on referral and utilization of parathyroidectomy has not been fully explored.
METHODS
Population-based, retrospective cohort study using 100% Medicare claims from beneficiaries with primary hyperparathyroidism from 2006 to 2016. Associations of race/ethnicity with disease severity, surgeon evaluation, and subsequent parathyroidectomy were analyzed using adjusted multivariable logistic regression models.
RESULTS
Among 210,206 beneficiaries with primary hyperparathyroidism, 63,136 (30.0%) underwent parathyroidectomy within 1 year of diagnosis. Black patients were more likely than other races/ethnicities to have stage 3 chronic kidney disease (10.8%) but had lower prevalence of osteoporosis and nephrolithiasis compared to White patients, Black and Hispanic patients were more likely to have been hospitalized for primary hyperparathyroidism-associated conditions (White 4.8%, Black 8.1%, Hispanic 5.8%; P < .001). Patients who were White and met operative criteria were more likely to undergo parathyroidectomy than Black, Hispanic, or Asian patients (White 30.5%, Black 23.0%, Hispanic 21.4%, Asian 18.7%; P < .001). Black and Hispanic patients had lower adjusted odds of being evaluated by a surgeon (odds ratios 0.71 [95% confidence interval 0.69-0.74], 0.68 [95% confidence interval 0.61-0.74], respectively) and undergoing parathyroidectomy if evaluated by a surgeon (odds ratios 0.72 [95% confidence interval 0.68-0.77], 0.82 [95% confidence interval 0.67-0.99]). Asian race was associated with lower adjusted odds of being evaluated by a surgeon (odds ratio 0.64 [95% confidence interval 0.57-0.71]), but no difference in odds of parathyroidectomy.
CONCLUSION
Racial/ethnic disparities exist in the management of primary hyperparathyroidism among older adults. Determining the factors that account for this disparity require urgent attention to achieve parity in the management of primary hyperparathyroidism.
背景
在原发性甲状旁腺功能亢进症患者中，甲状旁腺切除术提供了治愈和减轻与疾病相关并发症的机会。种族/民族对甲状旁腺切除术的转诊和利用的影响尚未得到充分探讨。
方法
这是一项基于人群的回顾性队列研究，使用了 2006 年至 2016 年期间患有原发性甲状旁腺功能亢进症的医疗保险受益人的 100%索赔数据。使用调整后的多变量逻辑回归模型分析了种族/民族与疾病严重程度、外科医生评估以及随后的甲状旁腺切除术之间的关联。
结果
在 210206 名患有原发性甲状旁腺功能亢进症的受益人中，63136 名（30.0%）在诊断后 1 年内接受了甲状旁腺切除术。与其他种族/民族相比，黑人患者更有可能患有 3 期慢性肾脏病（10.8%），但与白人患者相比，骨质疏松症和肾结石的患病率较低，与白人患者相比，黑人和西班牙裔患者更有可能因原发性甲状旁腺功能亢进症相关疾病住院（白人 4.8%，黑人 8.1%，西班牙裔 5.8%；P<.001）。符合手术标准的白人患者比黑人、西班牙裔或亚洲患者更有可能接受甲状旁腺切除术（白人 30.5%，黑人 23.0%，西班牙裔 21.4%，亚洲人 18.7%；P<.001）。黑人患者和西班牙裔患者接受外科医生评估的调整后比值比（比值比 0.71[95%置信区间 0.69-0.74]和 0.68[95%置信区间 0.61-0.74]）和接受外科医生评估后接受甲状旁腺切除术的调整后比值比（比值比 0.72[95%置信区间 0.68-0.77]和 0.82[95%置信区间 0.67-0.99]）均较低。亚洲种族与接受外科医生评估的调整后比值比较低（比值比 0.64[95%置信区间 0.57-0.71]），但甲状旁腺切除术的比值比没有差异。
结论
在老年人群中，原发性甲状旁腺功能亢进症的管理存在种族/民族差异。确定造成这种差异的因素需要引起紧急关注，以实现原发性甲状旁腺功能亢进症管理的均等化。
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