Disparities in Initial Thyroid Cancer Care by Hospital Treatment Volume: Analysis of 52,599 Cases in California

Huston-Paterson, Hattie; Mao, Yifan; Kim, Jiyoon; Tseng, Chi‐Hong; Yeh, Michael W.; Wu, James X.

doi:10.1089/thy.2023.0241

Cited by 9 publications

(3 citation statements)

References 23 publications

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“…However, our study also found that Medicare insurance was associated with lower likelihood of treatment in high-quality hospitals and higher likelihood of treatment in low-quality hospitals. This is consistent with studies of other cancer sites showing low rates of high-quality and high-volume hospital use among Medicare patients . We also found that treatment in high-quality hospitals was associated with receipt of guideline-compliant care.…”

Section: Discussionsupporting

confidence: 88%

“…This is consistent with studies of other cancer sites showing low rates of high-quality and high-volume hospital use among Medicare patients. 22,23 We also found that treatment in highquality hospitals was associated with receipt of guidelinecompliant care. However, the association between insurance status and receipt of guideline-compliant care did not appear to be mediated by hospital quality.…”

Section: Discussionmentioning

confidence: 65%

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Insurance Disparities in Quality of Care Among Patients With Head and Neck Cancer

Megwalu,

Ma,

Divi

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceSignificant insurance status disparities have been demonstrated in head and neck cancer (HNC) outcomes. The effects of insurance status on HNC outcomes may be explained by differential access to high-quality care.ObjectiveTo evaluate the association of insurance status with the quality of the treating hospital and receipt of guideline-compliant care among patients with HNC.Design, Setting, and ParticipantsThis retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Data were analyzed from May 10, 2023, to March 25, 2024.ExposuresInsurance status: commercial, Medicare, Medicaid, uninsured, other, or unknown.Main Outcomes and MeasuresQuality of the treating hospital (tertiles), receipt of National Comprehensive Cancer Network guideline-compliant care, and overall survival.ResultsA total of 23 933 patients (mean [SD] age, 64.8 [12.3] years; 75.3% male) met the inclusion criteria. Treatment in top-tertile hospitals (hazard ratio, 0.87; 95% CI, 0.79-0.95) was associated with improved overall survival compared with treatment in bottom-tertile hospitals. Medicare (odds ratio [OR], 0.78; 95% CI, 0.73-0.84), Medicaid (OR, 0.60; 95% CI, 0.54-0.66), and uninsured (OR, 0.38; 95% CI, 0.29-0.49) status were associated with lower likelihood of treatment in high-quality hospitals compared with commercial insurance. Among patients with advanced disease, Medicaid (OR, 0.72; 95% CI, 0.62-0.83) and uninsured (OR, 0.64; 95% CI, 0.44-0.93) patients were less likely to receive dual-modality therapy. Among patients with surgically resected advanced disease, Medicaid coverage (OR, 0.73; 95% CI, 0.58-0.93) was associated with lower likelihood of receiving adjuvant radiotherapy.Conclusions and RelevanceThis study found significant insurance disparities in quality of care among patients with HNC. These findings highlight the need for continued health insurance reform in the US to improve the quality of insurance coverage, in addition to expanding access to health insurance.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 65%

Insurance Disparities in Quality of Care Among Patients With Head and Neck Cancer

Megwalu,

Ma,

Divi

et al. 2024

JAMA Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…The findings revealed that metformin administration led to alterations in thyroid function in male rats, characterized by clinical manifestations of hyperthyroidism. The role of metformin in inhibiting TSH levels and increasing FT3 and FT4 levels highlights the importance of clinical awareness regarding the therapeutic intervention of metformin in thyroid-related conditions [ 29 ]. Also, another study has shown that sulfonylureas may increase the risk of thyroid cancer and the risk of hypothyroidism and goitre [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of Central and peripheral thyroid resistance indices on diabetic retinopathy: a study of hospitalized euthyroid patients with T2DM in China

Zhao,

Sun,

et al. 2023

Annals of Medicine

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Objective This study aims to explore the correlation between central and peripheral thyroid resistance indices and diabetic retinopathy(DR) in patients with type 2 diabetes mellitus (T2DM), so as to provide a clinical basis for the prevention and treatment of diabetic retinopathy. Methods This study retrospectively analyzed 1249 euthyroid patients with T2DM hospitalized in the Department of Endocrinology, Peking University International Hospital from January 2017 to June 2022, including 852 males and 397 females, with an average age of 54.73 ± 13.40 years. According to the degree of DR, the patients were divided into three groups including the no diabetic retinopathy (NDR) group, non-proliferative diabetic retinopathy (NPDR) group and proliferative diabetic retinopathy (PDR) group. Results Free thymidine (FT4), thyroid stimulating hormone (TSH), thyroid feedback quantile index (TFQI), thyrotropin-T4 resistance index (TT4RI), thyroid stimulating hormone index (TSHI) and free triiodothyronine/free thyroxine (FT3/FT4) levels among the three groups were significantly different, with the NDR group having lowest TSH, TFQI, TT4QI, TSHI and the highest in the PDR group (all p < 0.05). Logistic regression showed that after adjusting for age, body mass index (BMI), sex, diabetes duration, blood pressure, blood lipid, HbA1c, lower level of FT4 was an independent risk factor for DR, high level of TSH, TFQI, TSHI and TT4RI were independent risk factors for DR. Central and peripheral thyroid sensitivity indices have predictive value for DR, the overall predictive accuracy of FT3/FT4 was 0.61 (95%CI 0.57, 0.65), the overall predictive accuracy of TFQI was 0.66(95%CI 0.63, 0.70), the overall predictive accuracy of TSHI was 0.66(95%CI 0.62, 0.68), the overall predictive accuracy of TT4RI was 0.63 (95%CI 0.59, 0.66). Conclusion The reduction of central and peripheral thyroid hormone sensitivity is an independent risk factor for DR. These results can help predict the risk of the occurrence and development of DR, which may provide a clinical basis for the prevention and treatment of DR in T2DM patients.

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Implementation of the 2015 American Thyroid Association guideline changes across a health system: A quality improvement opportunity

Ginzberg,

Kalva,

Soegaard Ballester

et al. 2024

Surgical Oncology Insight

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Disparities in Initial Thyroid Cancer Care by Hospital Treatment Volume: Analysis of 52,599 Cases in California

Cited by 9 publications

References 23 publications

Insurance Disparities in Quality of Care Among Patients With Head and Neck Cancer

Insurance Disparities in Quality of Care Among Patients With Head and Neck Cancer

The effect of Central and peripheral thyroid resistance indices on diabetic retinopathy: a study of hospitalized euthyroid patients with T2DM in China

Implementation of the 2015 American Thyroid Association guideline changes across a health system: A quality improvement opportunity

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