Impact of Hospital Safety Net Burden on Thyroid Cancer Survival

Presentation: AHNS27
Topic: Endocrine Surgery
Type: Oral
Date: Thursday, April 28, 2022
Session: 9:00 AM – 9:45 AM Endocrine
Authors: Megh Shah, BA; Ryan Jin, BA; Christopher C Tseng, BS; Rushi Patel, BA; Dylan F Roden, MD; Richard C Park, MD
Institution(s): Rutgers New Jersey Medical School


To determine the impact of hospital safety net burden on survival for thyroid cancer patients.

Study Design: Retrospective database review.

Methods: The National Cancer Database (NCDB) was used to identify patients with primary, invasive thyroid cancers between 2004-2016. Patients with missing clinicopathological data were excluded. Hospital safety-net burden was defined by percentile of uninsured/Medicaid thyroid cancer patients treated per year: <25th percentile for low safety-net burden hospitals (LBH), between 25-75th percentile for medium (MBH), and ≥75th percentile for high (HBH). Univariate and multivariate analyses were performed to investigate the relationships between hospital safety net burden and patient demographics, tumor characteristics, and treatments.

Results: We queried 114,947 thyroid cancer cases in total. On univariate analysis, HBH compared to LBH and MBH had higher rates of patients with Charlson-Deyo score of 3+ (1.0% vs. 0.7% vs. 0.9%, p<0.001) and AJCC Stage 4 (0.8% vs. 0.4% vs. 0.4%, p<0.001). Utilizing multivariate analysis, demographic factors associated with treatment at HBH included Black race (OR 1.17 [1.11-1.24], p<0.001), Hispanic ethnicity (OR 1.42 [1.35-1.50], p<0.001), and being from rural area (OR 1.64 [1.46-1.83], p<0.001). Furthermore, staging factors associated with treatment at HBH were clinical stage T3 (OR 1.14 [1.07-1.23], p<0.001), cT4 disease (OR 1.34 [1.02-1.76], p=0.034), and clinical stage N1 (OR 1.17 [1.09-1.25], p<0.001). Conversely, patients living in the highest income quartile zip codes (OR 0.47 [0.45-0.50], p<0.001) or in areas with the highest quartile of high school graduation rates (OR 0.61 [0.57-0.64], p<0.001) had decreased odds for treatment at HBH. Kaplan-Meier analysis showed 10 year overall survival was improved for LBH versus MBH and HBH (88.8% vs. 87.0% vs. 86.0%, p<0.001). Compared to LBH, we found significantly higher mortality in patients treated at MBH (HR 1.13, 95% CI 1.05-1.21, p=0.001) and HBH (HR 1.17, 95% CI 1.08-1.27, p<0.001).

Conclusions: Thyroid cancer patients of lower socioeconomic status (SES) and advanced disease are more often treated at HBH. Further study is warranted to investigate and address the issue of lower SES patients presenting with higher stages of thyroid cancer, likely contributing to the poorer outcomes experienced at HBH.