Disparities in Thyroid Screening and Medication Use in Quebec, Canada.

Kathrin Stoll

doi:10.1089/heq.2018.0051

Abstract

Background: No studies have examined the frequency of thyroid screening in the Canadian population, and whether thyroid screening and medication use vary by sex, race, income, and preexisting health conditions.Methods: Using data from the 2011, 2012 cycles of the Canadian Community Health Survey, we report rates of thyroid screening among Quebec residents ≥35 (n=7024) and rates of thyroid medication use among Quebec residents ≥35 (n=16,081). We examine variations in medication use and screening by sex, age, race, immigration status, access to a regular doctor, and health conditions that have been linked to thyroid disease.Results: Of the Quebec residents ≥35, 10.3% reported taking thyroid medication and 0.4% reported that the last blood test a physician ordered was to check for a new thyroid condition. Canadian-born residents and those who identified as White reported higher medication use and screening rates, compared to immigrants and those who identified as visible minorities. Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities. The strongest predictors of both thyroid medication use and screening were access to a regular doctor. Despite women being eight times more likely to suffer from thyroid disease, women were not significantly more likely to be screened, compared to men (odds ratio=1.38, 95% confidence interval: 0.74–2.60).Discussion: Strategies are needed to decrease disparities in thyroid screening and medication use. Interventions that target health systems (e.g., increasing physician supply), providers (continuing professional education modules about thyroid disease for family physicians), and recipients of care (multilanguage public awareness campaigns and posters at walk-in clinics that describe common symptoms of different thyroid disorders) should be implemented and tested.

Highlights

Thyroid disease is one of the most underdiagnosed health conditions in the world; it is estimated that 50– 60% of people affected by thyroid disease in North America are not aware of their condition.[1,2] Early diagnosis is important, to improve quality of life and to prevent progression of the disease and other health conditions that are linked to untreated thyroid disorders.Hypothyroidism is the most common of the thyroid dysfunctions and the most common hormone deficiency.[3]
Thyroid medication use The prevalence of thyroid medication use among residents of Quebec was 7.5%; the prevalence among residents ‡35 was 10.3%
The odds of Quebec residents with a regular doctor being on thyroid medication were nearly six times greater than the odds of residents without a regular doctor

Summary

Introduction

Thyroid disease is one of the most underdiagnosed health conditions in the world; it is estimated that 50– 60% of people affected by thyroid disease in North America are not aware of their condition.[1,2] Early diagnosis is important, to improve quality of life and to prevent progression of the disease and other health conditions that are linked to untreated thyroid disorders.Hypothyroidism is the most common of the thyroid dysfunctions and the most common hormone deficiency.[3]. No studies have examined the frequency of thyroid screening in the Canadian population, and whether thyroid screening and medication use vary by sex, race, income, and preexisting health conditions. We examine variations in medication use and screening by sex, age, race, immigration status, access to a regular doctor, and health conditions that have been linked to thyroid disease. Canadian-born residents and those who identified as White reported higher medication use and screening rates, compared to immigrants and those who identified as visible minorities. Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities. Interventions that target health systems (e.g., increasing physician supply), providers (continuing professional education modules about thyroid disease for family physicians), and recipients of care (multilanguage public awareness campaigns and posters at walk-in clinics that describe common symptoms of different thyroid disorders) should be implemented and tested

Methods

Results

Discussion

Conclusion