Disparities in Thyroid Cancer Mortality Across Racial and Ethnic Groups: Assessing the Impact of Socioeconomic, Clinicopathologic, and Treatment Variations.

Abstract

Thyroid cancer remains a significant public health concern, with disparities in mortality rates observed across racial/ethnic groups. We quantified the extent to which socioeconomic, clinicopathologic, and treatment variations explain racial/ethnic disparities in thyroid cancer mortality. We studied a cohort of 109,981 thyroid cancer patients diagnosed from 2006 to 2018 using the United States Surveillance, Epidemiology, and End Results database. We used multivariable logistic regression to assess the association of race/ethnicity with treatment status. We also performed mediation analyses to estimate how much the racial/ethnic differences in thyroid cancer-specific mortality were explained by variations in treatment and clinicopathologic and socioeconomic factors. Non-hispanic (NH) Black patients were more likely to not receive the recommended surgical resection than NH White patients (adjusted odds ratio [aOR] 1.10, 95% confidence interval [CI] 1.02-1.20). NH Black patients had a significantly higher risk of all-cause mortality compared with NH White patients (adjusted hazards ratio [aHR] 1.19, 95% CI 1.07-1.31). Mediation analysis showed that socioeconomic status significantly explained 48.7% (indirect effect HR 1.07, 95% CI 1.01-1.14) of the difference in thyroid cancer-specific mortality between NH Black and NH White patients. This study found that race/ethnicity was associated with treatment status and the risk of mortality among patients diagnosed with thyroid cancer. Moreover, clinicopathologic and socioeconomic factors were identified as the most crucial mediators that explained the excess mortality among minority groups. These findings provide insight into the pathways through which disparities in thyroid cancer mortality in NH Black and Hispanic thyroid patients could operate.