Resident Physician Vanderbilt University Medical Center Vanderbilt University Medical Center
Introduction: Disparities across race and socioeconomic status (SES) in cancer treatment and outcomes exist for many malignancies. Disadvantaged groups have been shown to experience increased mortality and sub-optimal treatment. The impact of these differences has not previously been explored in pediatric thyroid cancer. We aim to analyze racial and SES disparities in the presentation and management of pediatric thyroid cancer.
Methods: Analysis of children who underwent a thyroidectomy for thyroid papillary, medullary, and follicular carcinoma was conducted using the SEER database 2007-2016. Race was classified as White, Non-White, and Hispanic. Insurance was classified as insured (non-Medicaid), Medicaid, and uninsured. SES was characterized at the census tract level. Multivariable logistic regression was conducted to identify predictors of 1) tumor stage/size at diagnosis and 2) treatment modalities.
Results: 1,942 children were analyzed. The average size of the tumor was 20 mm for White patients, 26 mm for Non-white patients, and 27 mm for Hispanic patients (p < 0.001). Extent of disease differed significantly by race/ethnicity (p=0.008), with non-White (4.5%) and Hispanic (3.9%) patients having more distant disease than White patients (3.4%). On multivariable regression models, Hispanics (OR 1.41, 95%CI 1.06-1.87, p=0.017) were more likely to be diagnosed with more extensive disease. Non-White patients (OR 2.03, 1.50-2.73, p<0.001) and Hispanic patients (OR 1.57, 1.19-2.07, p=0.002) had larger tumors at diagnosis than White patients after controlling for other SES factors.
Conclusion: Variations in presentation exist across race and insurance status. This research highlights the SES disparities in pediatric thyroid cancer with Black and Hispanic patients presenting with larger tumors and increased likelihood to present with distant disease compared to White patients. Further research should be devoted to reducing disparities in presentation.