Closing the Gap: Improving Access to Parathyroidectomy for Secondary and Tertiary Hyperparathyroidism

BackgroundPatients with secondary and tertiary hyperparathyroidism (SHPT/THPT) may encounter unique demographic and geographic barriers to timely parathyroidectomy that differ from those experienced by patients with primary hyperparathyroidism (PHPT).MethodsA retrospective cohort study was conducted at a large tertiary institution on patients who underwent parathyroidectomy between 2016 and 2023. Patients with duplicate records and missing data were excluded. Demographic variables were obtained from the parathyroid database while addresses were provided by the billing department and use to calculate distance to hospital (miles), Area Deprivation Index (ADI), and Social Vulnerability Index (SVI). Comparisons were performed using chi-squared, Fisher's exact test, t-tests, and Mann-Whitney U tests.ResultsAmong 818 patients, 105 (12.8%) either had SHPT or THPT while 713 (87.2%) had PHPT. Patients with SHPT/THPT when compared to patients with PHPT were younger, more likely to be male, and identify as minorities (P < 0.001). The SHPT/THPT group was less likely to be privately insured 36% vs 64% and had a higher percentage of Medicare patients 56.2% vs 27.3%, P < 0.001. The SHPT/THPT cohort traveled farther (Median: 89.2 miles (IQR: 34.7-147.9) vs 32.1 (11.0-74.8), P < 0.001) and resided in neighborhoods with higher ADI percentiles (82.0 (56.0-92.0) vs 68.0 (45.0-84.0), P < 0.001) and SVI percentiles (64.0 (34.0-79.0) vs 44.0 (19.0-69.0), P < 0.001).ConclusionThese findings identify opportunities to improve referral pathways and targeted interventions to ensure equitable and timely parathyroidectomy for patients with SHPT/THPT.