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Effects of socioeconomic status on children with well-differentiated thyroid cancer
Evan F Garner1, Ilan I Maizlin1, Matthew B Dellinger2
1Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
Insights
Socioeconomic factors like income and insurance affect pediatric well-differentiated thyroid cancer (WDTC) management. Lower income and uninsured children face diagnostic delays and higher stage at diagnosis, but survival remains unaffected.
Area of Science:
- Pediatric oncology
- Health services research
- Endocrine surgery
Background:
- Well-differentiated thyroid cancer (WDTC) is the most common pediatric endocrine malignancy.
- Socioeconomic disparities in adult thyroidectomy management are known, but pediatric WDTC disparities are understudied.
Purpose of the Study:
- To investigate the impact of socioeconomic status on the diagnosis and management of pediatric well-differentiated thyroid cancer.
- To identify potential delays in care and differences in disease presentation based on socioeconomic factors.
Main Methods:
- Retrospective review of 9,585 patients ≤21 years old with WDTC from the National Cancer Data Base.
- Analysis of socioeconomic surrogate variables: insurance type, median income, and educational quartile.
- Comparison of tumor characteristics, diagnostic intervals, and clinical outcomes across socioeconomic groups.
Main Results:
- Lower income, lower educational quartile, and insurance status correlated with higher stage at diagnosis.
- Children from lower income quartiles and those uninsured experienced longer diagnosis-to-treatment intervals.
- Despite diagnostic delays and higher stage at presentation, no significant differences in overall survival or readmission rates were observed based on socioeconomic status.
Conclusions:
- Children from lower socioeconomic backgrounds with WDTC face delays in treatment and present with more advanced disease.
- These disparities suggest potential barriers to timely care for vulnerable pediatric populations.
- While current outcomes were not significantly worse, efforts are needed to mitigate these socioeconomic-driven differences in pediatric cancer care.
Background:
Well-differentiated thyroid cancer is the most common endocrine malignancy in children. Adult literature has demonstrated socioeconomic disparities in patients undergoing thyroidectomy, but the effects of socioeconomic status on the management of pediatric well-differentiated thyroid cancer remains poorly understood.
Methods:
Patients ≤21 years of age with well-differentiated thyroid cancer remains were reviewed from the National Cancer Data Base. Three socioeconomic surrogate variables were identified: insurance type, median income, and educational quartile. Tumor characteristics, diagnostic intervals, and clinical outcomes were compared within each socioeconomic surrogate variable.
Results:
A total of 9,585 children with well-differentiated thyroid cancer remains were reviewed. In multivariate analysis, lower income, lower educational quartile, and insurance status were associated with higher stage at diagnosis. Furthermore, lower income quartile was associated with a longer time from diagnosis to treatment (P < .002). Similarly, uninsured children had a longer time from diagnosis to treatment (28 days) compared with those with government (19 days) or private (18 days) insurance (P < .001). Despite being diagnosed at a higher stage and having a longer time interval between diagnosis and treatment, there was no significant difference in either overall survival or rates of unplanned readmissions based on any of the socioeconomic surrogate variables.
Conclusion:
Children from lower income families and those lacking insurance experienced a longer period from diagnosis to treatment of their well-differentiated thyroid cancer remains. These patients also presented with higher stage disease. These data suggest a delay in care for children from low-income families. Although these findings did not translate into worse outcomes for well-differentiated thyroid cancer remains, future efforts should focus on reducing these differences.
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