Race and Gender Disparities in Access to Parathyroidectomy: A Need to Change Processes for Diagnosis and Referral to Surgeons.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
22
08
2019
pubmed:
17
6
2020
medline:
11
3
2021
entrez:
17
6
2020
Statut:
ppublish
Résumé
Hyperparathyroidism substantially impairs quality of life, and effective treatment depends on timely referral to surgeons. We hypothesized that there would be race and gender disparities in the time from initial diagnosis of hyperparathyroidism to treatment with parathyroidectomy. We reviewed administrative data on 2289 patients with hypercalcemia (calcium > 10.5 mg/dL) and abnormal parathyroid hormone levels who were seen at a tertiary referral center from 2011 to 2016. We used two-phase parametric hazard modeling to identify predictors of time from index abnormal calcium until parathyroidectomy. The median age of our cohort was 63 years, and 1685 (74%) were women. Of the total patients, 1301 (57%) were Caucasian, and 946 (41%) were African-American. Only 490 (21%) patients underwent parathyroidectomy. Among patients undergoing surgery, time from index high calcium to surgical treatment was longest for African-American men, who waited a median of 13.6 months (interquartile range IQR 2-28), compared with 2.9 months (IQR 1-8) for Caucasian males (p < 0.05). African-American women waited a median of 6.7 months (IQR 2-16) versus 3.5 months (IQR 2-14) for Caucasian women (p < 0.05). At 1 year after the index abnormal calcium, only 6% of black men underwent surgery compared with 20% of white males (p < 0.05). Similarly, 13% of black women underwent surgery versus 20% of white women (p < 0.05). These differences remained significant after adjusting for age, calcium levels, insurance, and comorbidities. African-Americans face substantial delays in access to parathyroidectomy after diagnosis with hyperparathyroidism that could impair quality of life and increase health care costs. We must improve systems of diagnosis and referral to ensure timely treatment of hyperparathyroidism.
Sections du résumé
BACKGROUND
BACKGROUND
Hyperparathyroidism substantially impairs quality of life, and effective treatment depends on timely referral to surgeons. We hypothesized that there would be race and gender disparities in the time from initial diagnosis of hyperparathyroidism to treatment with parathyroidectomy.
METHODS
METHODS
We reviewed administrative data on 2289 patients with hypercalcemia (calcium > 10.5 mg/dL) and abnormal parathyroid hormone levels who were seen at a tertiary referral center from 2011 to 2016. We used two-phase parametric hazard modeling to identify predictors of time from index abnormal calcium until parathyroidectomy.
RESULTS
RESULTS
The median age of our cohort was 63 years, and 1685 (74%) were women. Of the total patients, 1301 (57%) were Caucasian, and 946 (41%) were African-American. Only 490 (21%) patients underwent parathyroidectomy. Among patients undergoing surgery, time from index high calcium to surgical treatment was longest for African-American men, who waited a median of 13.6 months (interquartile range IQR 2-28), compared with 2.9 months (IQR 1-8) for Caucasian males (p < 0.05). African-American women waited a median of 6.7 months (IQR 2-16) versus 3.5 months (IQR 2-14) for Caucasian women (p < 0.05). At 1 year after the index abnormal calcium, only 6% of black men underwent surgery compared with 20% of white males (p < 0.05). Similarly, 13% of black women underwent surgery versus 20% of white women (p < 0.05). These differences remained significant after adjusting for age, calcium levels, insurance, and comorbidities.
CONCLUSIONS
CONCLUSIONS
African-Americans face substantial delays in access to parathyroidectomy after diagnosis with hyperparathyroidism that could impair quality of life and increase health care costs. We must improve systems of diagnosis and referral to ensure timely treatment of hyperparathyroidism.
Identifiants
pubmed: 32542566
doi: 10.1245/s10434-020-08707-z
pii: 10.1245/s10434-020-08707-z
doi:
Substances chimiques
Parathyroid Hormone
0
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
476-483Subventions
Organisme : NIA NIH HHS
ID : GEMSSTAR R03 (1R03AG056330-01)
Pays : United States
Organisme : Agency for Health Research and Quality
ID : K12 grant (K12 HS023009-03)
Organisme : NIA NIH HHS
ID : GEMSSTAR R03 (1R03AG056330-01)
Pays : United States
Références
Clark OH. Hyperparathyroidism. Surg Technol Int. 1991;I:291–4.
pubmed: 28581574
Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122–9.
doi: 10.1210/jc.2012-4022
Khosla S, Melton LJ, 3rd, Wermers RA, Crowson CS, O'Fallon W, Riggs B. Primary hyperparathyroidism and the risk of fracture: a population-based study. J Bone Miner Res. 1999;14(10):1700–7.
doi: 10.1359/jbmr.1999.14.10.1700
Mollerup CL, Vestergaard P, Frokjaer VG, Mosekilde L, Christiansen P, Blichert-Toft M. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ. 2002;325(7368):807.
doi: 10.1136/bmj.325.7368.807
Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L. Cardiovascular events before and after surgery for primary hyperparathyroidism. World J Surg. 2003;27(2):216–22.
doi: 10.1007/s00268-002-6541-z
Yu N, Donnan PT, Leese GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol. 2011;75(2):169–76.
doi: 10.1111/j.1365-2265.2010.03958.x
Hagström E, Hellman P, Larsson TE, et al. Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation. 2009;119(21):2765–71.
doi: 10.1161/CIRCULATIONAHA.108.808733
Zanocco KA, Wu JX, Yeh MW. Parathyroidectomy for asymptomatic primary hyperparathyroidism: a revised cost-effectiveness analysis incorporating fracture risk reduction. Surgery. 2017;161(1):16–24.
doi: 10.1016/j.surg.2016.06.062
Lou I, Balentine C, Clarkson S, Schneider DF, Sippel RS, Chen H. How long should we follow patients after apparently curative parathyroidectomy? Surgery. 2017;161(1):54–61.
doi: 10.1016/j.surg.2016.05.049
Balentine CJ, Xie R, Kirklin JK, Chen H. Failure to diagnose hyperparathyroidism in 10,432 patients with hypercalcemia: opportunities for system-level intervention to increase surgical referrals and cure. Ann Surg. 2017;266(4):632–40.
doi: 10.1097/SLA.0000000000002370
Press DM, Siperstein AE, Berber E, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013;154(6):1232–7; discussion 1237–8.
Wu JX, Yeh MW. Asymptomatic primary hyperparathyroidism: diagnostic pitfalls and surgical intervention. Surg Oncol Clin N Am. 2016;25(1):77–90.
doi: 10.1016/j.soc.2015.08.004
Alore EA, Suliburk JW, Ramsey DJ, et. al. Diagnosis and management of primary hyperparathyroidism across the veterans affairs health care system. JAMA Internal Med. 2019. https://doi.org/10.1001/jamainternmed.2019.1747
doi: 10.1001/jamainternmed.2019.1747
Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994;272(12):947–54.
doi: 10.1001/jama.1994.03520120057031
Bach PB, Schrag D, Brawley OW, Galaznik A, Yakren S, Begg CB. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002;287(16):2106–13.
doi: 10.1001/jama.287.16.2106
Jolly S, Vittinghoff E, Chattopadhyay A, Bibbins-Domingo K. Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites. Am J Med. 2010;123(9):811–8.
doi: 10.1016/j.amjmed.2010.04.020
Liff JM, Chow WH, Greenberg RS. Rural-urban differences in stage at diagnosis. Possible relationship to cancer screening. Cancer. 1991;67(5):1454–9.
doi: 10.1002/1097-0142(19910301)67:5<1454::AID-CNCR2820670533>3.0.CO;2-K
Chow CJ, Al-Refaie WB, Abraham A, et al. Does patient rurality predict quality colon cancer care?: A population-based study. Dis Colon Rectum. 2015;58(4):415–22.
doi: 10.1097/DCR.0000000000000173
Schroder SL, Richter M, Schroder J, Frantz S, Fink A. Socioeconomic inequalities in access to treatment for coronary heart disease: a systematic review. Int J Cardiol. 2016;219:70–8.
doi: 10.1016/j.ijcard.2016.05.066
Clark AM, DesMeules M, Luo W, Duncan AS, Wielgosz A. Socioeconomic status and cardiovascular disease: risks and implications for care. Nat Rev Cardiol. 2009;6(11):712–22.
doi: 10.1038/nrcardio.2009.163
Katz SJ, Hofer TP. Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States. JAMA. 1994;272(7):530–4.
doi: 10.1001/jama.1994.03520070050037
Sosa JA, Mehta PJ, Wang TS, Yeo HL, Roman SA. Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg. 2007;246(6):1083–91.
doi: 10.1097/SLA.0b013e31812eecc4
Shah SA, Adam MA, Thomas SM, et al. Racial disparities in differentiated thyroid cancer: have we bridged the gap? Thyroid. 2017;27(6):762–72.
doi: 10.1089/thy.2016.0626
Golden SH, Brown A, Cauley JA, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors—an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2012;97(9):E1579–39.
doi: 10.1210/jc.2012-2043
Al-Qurayshi Z, Randolph GW, Srivastav S, Aslam R, Friedlander P, Kandil E. Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope. 2016;126(9):2194–9.
doi: 10.1002/lary.25871
Noureldine SI, Abbas A, Tufano RP, et al. The impact of surgical volume on racial disparity in thyroid and parathyroid surgery. Ann Surg Oncol. 2014;21(8):2733–9.
doi: 10.1245/s10434-014-3610-0
Jang S, Mandabach M, Aburjania Z, Balentine CJ, Chen H. Racial disparities in the cost of surgical care for parathyroidectomy. J Surg Res. 2018;221:216–21.
doi: 10.1016/j.jss.2017.08.037
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.
doi: 10.1097/00005650-199801000-00004
Blackstone EH, Naftel DC, Turner ME. The decomposition of time-varying hazard into phases, each incorporating a separate stream of concomitant information. J Am Stat Assoc. 1986;81(395):615–24.
doi: 10.1080/01621459.1986.10478314
Jones DJ, Crump AD, Lloyd JJ. Health disparities in boys and men of color. Am J Public Health. 2012;102(Suppl 2):S170–2.
doi: 10.2105/AJPH.2011.300646
Lurie N, Dubowitz T. Health disparities and access to health. JAMA. 2007;297(10):1118–21.
doi: 10.1001/jama.297.10.1118
Hargraves JL. Trends in health insurance coverage and access among black, Latino and white Americans, 2001–2003. Track Rep. 2004(11):1–6.
Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Med Care Res Rev. 2000;57(Suppl 1):11–35.
doi: 10.1177/1077558700057001S02
Eisenberg JM, Power EJ. Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality. JAMA. 2000;284(16):2100–7.
doi: 10.1001/jama.284.16.2100
Ali NM, Combs RM, Muvuka B, Ayangeakaa SD. Addressing health insurance literacy gaps in an urban African American population: a qualitative study. J Community Health. 2018;43(6):1208–16
doi: 10.1007/s10900-018-0541-x
Osborn CY, Cavanaugh K, Wallston KA, et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun. 2011;16(Suppl 3):268–78.
doi: 10.1080/10810730.2011.604388
Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005;165(17):1946–52.
doi: 10.1001/archinte.165.17.1946
Probst JC, Laditka SB, Wang JY, Johnson AO. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res. 2007;7:40.
doi: 10.1186/1472-6963-7-40
Taber JM, Leyva B, Persoskie A. Why do people avoid medical care? A qualitative study using national data. J Gen Intern Med. 2015;30(3):290–7.
doi: 10.1007/s11606-014-3089-1
Eiser AR, Ellis G. Viewpoint: cultural competence and the African American experience with health care: the case for specific content in cross-cultural education. Acad Med. 2007;82(2):176–83.
doi: 10.1097/ACM.0b013e31802d92ea