Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: AHNS28
Session Name: Scientific Session 6 - Endocrine
Session Date: Thursday, May 15, 2025
Session Time: 1:00 PM - 1:45 PM
Association of Socioeconomic, Neighborhood, and Institutional Factors with Presentation in Differentiated Thyroid Cancer: A Population-Based Study of California from 1988 to 2020
Nazineen Kandahari, MD, MS1; Mindy C DeRouen, PhD, MPH2; Stephen Li MPH2; Trevor G Hackman, MD, FACS1; Gregory W Randolph, MD, FACS, FACE3; Marika D Russell, MD, FACS3; 1Department of Otolaryngology, University of North Carolina-Chapel Hill; 2Department of Epidemiology and Biostatistics, University of California, San Francisco; 3Department of Otolaryngology, Harvard Medical School and Massachusetts Eye and Ear InfirmaryBackground: The incidence of thyroid cancer is increasing in the United States.1,2 Studies have demonstrated racial/ethnic disparities in thyroid cancer survival but the effect of neighborhood socioeconomic status (nSES) and institutional-level factors remains understudied.3,4
Objective: To examine associations between multilevel sociodemographic factors and prognostic factors at presentation in differentiated thyroid cancer.
Methods: We conducted a population-based study among adults with differentiated thyroid cancer with data collected in the California Cancer Registry (CCR) between 1988 to 2020. Multilevel factors examined included race/ethnicity, insurance status, neighborhood SES (nSES), and receipt of care from an NCI-designated Cancer Center. Outcome measures were select prognostic factors (i.e., histology, stage, tumor size). We examined descriptive data distributions and used multivariable logistic regression to examine associations between multilevel sociodemographic factors (nSES, race/ethnicity, and sex) and stage at diagnosis, adjusting for year and age at diagnosis.
Results: Among 88,894 individuals diagnosed with thyroid cancer, 77% were female, 92% had papillary thyroid carcinoma, and 63% were diagnosed with localized disease. Nearly half (48%) were non-Hispanic (NH) White, followed by 27% Hispanic, 17% NH Asian American/Pacific Islander, 3.6% NH Black, and 2.5% Middle Eastern. Most were married (62%) or had private insurance (70%). More thyroid cancers were diagnosed among residents of higher SES neighborhoods (24% Q5 vs. 13% Q1). Among patients living in the lowest SES neighborhoods, there was relatively more follicular carcinoma (6.9% Q1 vs. 5.6% Q5), distant metastases (5.5% Q1 vs. 3.1% Q5), and larger tumors. Hispanic individuals were more likely to live in the lowest SES neighborhoods (60% in Q1) and presented more often with regional (32%) or distant (31%) metastases and larger tumors (32% >4.0cm vs. 23% <1.0cm). The proportion of individuals receiving care from NCI-designated cancer centers decreased with decreasing nSES (23% Q5 to 14% Q1). In multivariable models, the odds of presenting with distant metastases increased with decreasing nSES (OR Q1 vs. Q5=1.54; 95% CI=1.37, 1.75) and being NH Asian American/Pacific Islander (OR=1.95; 95% CI=1.78, 2.15), NH Black (OR=1.36; 95%CI=1.15, 1.62) and Hispanic (OR=2.1; 95%CI=1.94, 2.32).
Conclusion: Despite more thyroid cancers being diagnosed among residents of higher SES neighborhoods, lower nSES was associated with later stage at diagnosis. Similarly, nearly half of those diagnosed with differentiated thyroid cancer were NH White, but NH Asian American/Pacific Islander, NH Black, and Hispanic populations were more likely to present with advanced disease. These findings illuminate the impact of multilevel social determinants of health on thyroid cancer presentation. Ongoing analyses will examine associations between multilevel sociodemographic factors and thyroid cancer survival.
References:
1. Surveillance Research Program NCI. https://seer.cancer.gov/faststats
2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820
3. Harari A, Li N, Yeh MW. Racial and socioeconomic disparities in presentation and outcomes of well-differentiated thyroid cancer. J Clin Endocrinol Metab. 2014;99(1):133-141. doi:10.1210/jc.2013-2781
4. Luff MK, Kim J, Tseng CH, Livhits MJ, Yeh MW, Wu JX. Racial/ethnic disparities in thyroid cancer in California, 1999-2017. Am J Surg. 2023;225(2):298-303. doi:10.1016/j.amjsurg.2022.09.041