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Primary hyperparathyroidism in the underinsured: a study of 493 patients

Azad A Jabiev1, John I Lew, Jane L Garb

  • 1Division of Endocrine Surgery, University of Miami, Miami, FL, USA.

Surgery
|October 18, 2011
PubMed

Insights

Underinsured patients with primary hyperparathyroidism (HPT) present with higher calcium and PTH levels, more hypercalcemic crisis, and less follow-up. Health insurance coverage impacts HPT care disparities.

Area of Science:

  • Endocrinology
  • Health Services Research

Background:

  • Disparities in primary hyperparathyroidism (HPT) care may exist.
  • This study investigates the presentation and outcomes of underinsured patients undergoing parathyroidectomy.

Purpose of the Study:

  • To examine the clinical characteristics and treatment outcomes of underinsured patients with HPT.
  • To identify disparities in HPT care associated with insurance status.

Main Methods:

  • A cohort of 493 HPT patients undergoing initial parathyroidectomy was divided into underinsured (n=94) and insured (n=399) groups.
  • Univariate and multivariate analyses were performed to assess the association of underinsurance with clinical variables, adjusting for race and ethnicity.

Main Results:

  • Underinsured patients were more likely to be of Black or Hispanic background (92% vs. 44%).
  • Group 1 patients had higher mean preoperative serum calcium (12.1 vs. 11.8 mg/dL) and PTH levels (263 vs. 198 pg/mL).
  • Underinsurance was associated with higher calcium levels (P=.011) and hypercalcemic crisis (OR, 5.59; P=.012). Shorter follow-up (15 vs. 24 months) and higher postoperative PTH levels (76 vs. 48 pg/mL) were observed in underinsured patients.

Conclusions:

  • Underinsured patients with HPT exhibit distinct clinical presentations, including higher calcium and PTH levels and increased risk of hypercalcemic crisis.
  • These patients are less likely to complete follow-up care.
  • Underfunded health insurance coverage appears to be a significant factor contributing to observed disparities in HPT management.
Abstract

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