Socioeconomic factors are associated with the prognosis of Thyroid Cancer

Background: Thyroid adenomas/adenocarcinomas are the most common type of thyroid cancer. The impact of socioeconomic factors on the prognosis of thyroid cancer is unclear. Methods: Clinical information and socioeconomic factors were obtained from the Surveillance, Epidemiology, and End Results Database (SEER) 18 Registries Custom Database. The association between thyroid adenomas/adenocarcinomas and socioeconomic factors including gender, race/ethnicity, insurance status, marital status, living area, and Yost index (including education, income, working, etc.) were fully evaluated. Results: A total of 136,313 patients between 2010 and 2016 were finally included in the present study. Among them, 126,160 patients were diagnosed with the single malignancy. Median follow-up time was 64 months. In general, non-Hispanic Asian or Pacific Islander and Hispanic patients had significantly better survival than non-Hispanic White patients (All P <0.05). Patients insured by Medicaid had significantly poorer cancer-specific survival (CSS, hazard ratio, HR=2.15, P <0.001) and overall survival (OS, HR=2.42, P <0.001) than those insured by commercial insurance or Medicare. In addition, divorced or widowed status, rural living location and low Yost index were significantly associated with poor CSS and OS of thyroid adenomas/adenocarcinomas (All P <0.05). Subgroup analyses showed similar results in patients who received surgical procedure, as well as in patients who received both surgical and radiation therapy. Multivariate analyses suggested that insurance status, marital status and Yost index remained significantly associated with CSS and OS (all P <0.05). Conclusions: Socioeconomic factors, including insurance status, marital status, living area, and Yost index, were significant predictors for the survival of thyroid adenomas/adenocarcinomas.