Socioeconomic Factors Affect Outcomes in Well-Differentiated Thyroid Cancer
Swegal WC, Singer M, Peterson E, Feigelson HS, Kono SA, Snyder S, Melvin TN, Calzada G, Ghai NR, Saman DM, and Chang SS. Socioeconomic Factors Affect Outcomes in Well-Differentiated Thyroid Cancer Otolaryngol Head Neck Surg 2016 Mar;154(3):440-5.
Otolaryngology and head and neck surgery
OBJECTIVES: The effects of socioeconomic status (SES) on the incidence of well-differentiated thyroid cancer (WDTC) are well researched. However, the association between SES and outcomes is not delineated. Our objective was to determine if SES affected outcomes of WDTC.
STUDY DESIGNS: Retrospective database review.
SETTING: Tertiary care medical center.
SUBJECTS AND METHODS: The Henry Ford Virtual Data Warehouse Tumor Registry was used to identify cases of WDTC. Socioeconomic data were obtained through the 2010 US Census: median household income, percentage below poverty line, median household size, percentage rent versus own property, and general demographics. Survival was the primary outcome. Disease-specific survival was also calculated. Cox proportional hazards were calculated and a multivariate analysis performed.
RESULTS: There were 1317 patients with WDTC. In multivariable analysis, median household income (hazard ratio [HR]: 0.85, 95% confidence interval [95% CI]: 0.79-0.91), household size (HR: 1.49, 95% CI: 1.09-2.14), younger age (HR: 1.97, 95% CI: 1.74-2.23), and female sex (HR: 0.50, 95% CI: 0.37-0.69) were significantly associated with survival. Controlling for stage revealed percentage below poverty line (stage I, HR: 0.51, 95% CI: 1.34-1.78; stage IV, HR: 1.28, 95% CI: 1.04-1.57) and median household income (HR: 0.84, 95% CI: 0.71-0.99) to be significant factors in survival. Median household income was a statistically significant variable for disease-related death (HR: 0.82, 95% CI: 0.69-0.96) CONCLUSIONS: Along with effects on incidence, lower SES correlates with worse survival in WDTC. This suggests that a patient's economic background, with younger age and female sex, influences one's outcomes with regard to both overall and disease-specific death.
Medical Subject Headings
Demography; Female; Humans; Incidence; Male; Michigan; Middle Aged; Neoplasm Staging; Registries; Retrospective Studies; Risk Factors; Social Class; Survival Analysis; Thyroid Neoplasms