Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA; Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.
Section of Endocrine Surgery, Department of Surgery, Columbia University, New York, NY.
Surgery. 2024 Jan;175(1):57-64. doi: 10.1016/j.surg.2023.04.062. Epub 2023 Oct 21.
Whereas racial disparities in thyroid cancer care are well established, the role of social determinants of health is less clear. We aimed to assess the individual and cumulative impact of social determinants of health on mortality and time to treatment among patients with thyroid cancer.
We collected social determinants of health data from thyroid cancer patients registered in the National Cancer Database from 2004 to 2017. We created a count variable for patients in the lowest quartile of each social determinant of health (ie, low income, low education, and no insurance). We assessed the association of social determinants of health with mortality and time to treatment and the association between cumulative social determinants of health count and time to treatment using Cox regression.
Of the 142,024 patients we identified, patients with longer time to treatment had greater mortality compared to patients treated within 90 days (90-180 days, adjusted hazard ratio 1.21 (95% confidence interval 1.13-1.29, P < .001); >180 days, adjusted hazard ratio 1.57 (95% confidence interval 1.41-1.76, (P < .001). Compared to patients with no adverse social determinants of health, patients with 1, 2, or 3 adverse social determinants of health had a 10%, 12%, and 34%, respectively, higher likelihood of longer time to treatment (1 social determinant of health, hazard ratio 0.90, 95% confidence interval 0.89-0.92, P < .001; 2 social determinants of health, hazard ratio 0.88, 95% confidence interval 0.87-0.90, P < .001; 3 social determinants of health, hazard ratio 0.66, 95% confidence interval 0.62-0.71, P < .001 for all). On subgroup analysis by race, each adverse social determinant of health was associated with an increased likelihood of a longer time to treatment for Black and Hispanic patients (P < .05).
A greater number of adverse social determinants of health leads to a higher likelihood of a longer time to treatment for patients with thyroid cancer, which, in turn, is associated with an increased risk for mortality.
尽管甲状腺癌治疗中的种族差异已得到充分证实，但健康的社会决定因素的作用尚不清楚。我们旨在评估社会决定因素对甲状腺癌患者死亡率和治疗时间的个体和累积影响。
我们从 2004 年至 2017 年在国家癌症数据库中登记的甲状腺癌患者中收集了社会决定因素的数据。我们为每个社会决定因素（即低收入、低教育和没有保险）处于最低四分位数的患者创建了一个计数变量。我们使用 Cox 回归评估了社会决定因素与死亡率和治疗时间之间的关联，以及累积社会决定因素计数与治疗时间之间的关联。
在我们确定的 142024 名患者中，治疗时间较长的患者与 90 天内接受治疗的患者相比，死亡率更高（90-180 天，调整后的危险比 1.21（95%置信区间 1.13-1.29，P<.001）；>180 天，调整后的危险比 1.57（95%置信区间 1.41-1.76，P<.001）。与没有不利社会决定因素的患者相比，有 1、2 或 3 个不利社会决定因素的患者的治疗时间延长的可能性分别高出 10%、12%和 34%（1 个社会决定因素，危险比 0.90，95%置信区间 0.89-0.92，P<.001；2 个社会决定因素，危险比 0.88，95%置信区间 0.87-0.90，P<.001；3 个社会决定因素，危险比 0.66，95%置信区间 0.62-0.71，P<.001）。按种族进行亚组分析时，每个不利的社会决定因素与黑人患者和西班牙裔患者治疗时间延长的可能性增加有关（P<.05）。
不利社会决定因素的数量越多，甲状腺癌患者的治疗时间延长的可能性就越大，而这反过来又与死亡率的增加有关。
