Disparities in Parathyroidectomy: Who Receives Appropriate Treatment for Primary Hyperparathyroidism?

Area of Science:

• Endocrinology
• Surgical Oncology
• Health Services Research

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder often undertreated with parathyroidectomy, despite established benefits.
• Surgical intervention for PHPT is crucial for managing hypercalcemia and its associated complications, yet disparities in access exist.

Purpose of the Study:

• To evaluate disparities in the receipt of parathyroidectomy among patients diagnosed with PHPT.
• To identify potential barriers to surgical care for PHPT, focusing on demographic and insurance-related factors.

Main Methods:

• A retrospective analysis of adult patients diagnosed with PHPT between 2013-2018 within a health system.
• Kaplan-Meier and multivariable Cox proportional hazards analyses were used to assess parathyroidectomy rates and associated factors.

Main Results:

• Of 2409 patients, 50% underwent parathyroidectomy within one year; this rate was higher (54%) among those meeting strong surgical indications.
• Patients with commercial/self-pay/uninsured status and younger age (≤50 years) were more likely to receive parathyroidectomy.
• Patients with Medicaid/Medicare insurance experienced longer median times to surgery and were less likely to undergo the procedure, even with strong indications.

Conclusions:

• Significant disparities in parathyroidectomy for PHPT were observed, particularly linked to insurance type.
• Patients with governmental insurance faced delays and reduced likelihood of surgery, indicating barriers to care access.
• Further investigation into referral and surgical access barriers is needed to ensure equitable treatment for all PHPT patients.