Gender, race and socioeconomic influence on diagnosis and treatment of thyroid disorders in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

Thyroid diseases are common, and use of levothyroxine is increasing worldwide. We investigated the influence of gender, race and socioeconomic status on the diagnosis and treatment of thyroid disorders using data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35-74 years of age) from six Brazilian cities. Diagnosis of thyroid dysfunction was by thyrotropin (TSH), and free thyroxine (FT4) if TSH was altered, and the use of specific medications. Multivariate logistic regression models were constructed using overt hyperthyroidism/hypothyroidism and levothyroxine use as dependent variables and sociodemographic characteristics as independent variables. The frequencies of overt hyper- and hypothyroidism were 0.7 and 7.4%, respectively. Using whites as the reference ethnicity, brown, and black race were protective for overt hypothyroidism (OR=0.76, 95%CI=0.64-0.89, and OR=0.53, 95%CI=0.43-0.67, respectively, and black race was associated with overt hyperthyroidism (OR=1.82, 95%CI=1.06-3.11). Frequency of hypothyroidism treatment was higher in women, browns, highly educated participants and those with high net family incomes. After multivariate adjustment, levothyroxine use was associated with female gender (OR=6.06, 95%CI=3.19-11.49) and high net family income (OR=3.23, 95%CI=1.02-10.23). Frequency of hyperthyroidism treatment was higher in older than in younger individuals. Sociodemographic factors strongly influenced the diagnosis and treatment of thyroid disorders, including the use of levothyroxine.

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“…In males (see Table 2) the proportion of hyperthyroidism is 2.7 % which is high compared to females which is 2.5 %. The proportion of hypothyroidism, subclinical hypothyroidism and subclinical hyperthyroidism is high among females as compared to males being 4.6%, 11.3% and 2.2% as compared to that of males being 4.2 %, 7.1 % and 1.8 % respectively which is in accordance to the findings of Olmos 23 and Aquino 24 .…”

Postmenopausal hormone therapy in the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil): who still uses it?

“…49 After that, the vast majority of male and female specialists in this area admitted being aware of the WHI results (95.9%), and although 84.6% stated that those results could not be extrapolated to forms of HT other than those evaluated in the study, a significant decrease in prescription was self-reported. 50 Another finding of the ELSA-Brasil study was the inappropriate use of thyroxine by more educated women and those with higher incomes 51 and of benzodiazepines by those with health insurance, 52 and this would appear to support this interpretation of the results and indicate the need for further studies on the quality of the private medical care often used by the more privileged socioeconomic classes in Brazil.…”

Thyroid disorders in Brazil: time for action

“…cities. 16 ELSA-Brasil showed that participants with subclinical hyperthyroidism had a 2.5 times greater chance of presenting panic disorder, while those who had subclinical hypothyroidism had a 25% lower frequency of generalized anxiety disorder.…”