Socioeconomic Factors Affect Outcomes in Well-Differentiated Thyroid Cancer. (March 2016)

• Record Type: Journal Article
• Authors: Swegal, Warren C.; Singer, Michael; Peterson, Edward; Feigelson, Heather Spencer; Kono, Scott A.; Snyder, Susan; Melvin, Thuy-Anh N.; Calzada, Gabriel; Ghai, Nirupa R.; Saman, Daniel M.; Chang, Steven S.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 154:Number 3(2016:Mar.)
• Page Start: 440
• Page End: 445
• Publication Date: 2016-03
• Subjects: well differentiated thyroid cancer -- socioeconomic status -- median household income; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599815620778
• Languages: English
• ISSNs: 0194-5998

Abstract

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.