Racial, ethnic, and socioeconomic disparities in the presentation and management of pediatric thyroid cancer.

Abstract

Disparities across race and socioeconomic status (SES) in cancer treatment exist for many malignancies. Disadvantaged groups have repeatedly been shown to receive sub-optimal treatment. This study intends to analyze racial and SES disparities in the presentation and management of pediatric thyroid cancer. A retrospective national database study of children who underwent thyroidectomy for thyroid papillary, medullary, and follicular carcinoma between 2007 and 2016 was conducted using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression was conducted to identify predictors of 1) tumor stage/size at diagnosis and 2) treatment modalities. 1942 children were analyzed. The average tumor size at presentation was 20mm for White patients, 26mm for Non-White patients, and 27mm for Hispanic patients (p<0.001). Stage of disease differed significantly by race/ethnicity (p<0.001) with Non-White and Hispanic patients having more distant disease than White patients at presentation. On multivariable regression, Hispanic patients (OR 1.41, 95%CI 1.06-1.87, p=0.017) were more likely to be diagnosed at later stages. Non-White (OR 2.03, 1.50-2.73, p<0.001) and Hispanic patients (OR 1.57, 1.19-2.07, p=0.002) had larger tumors at diagnosis than White patients after controlling for other SES factors. SES disparities exist in pediatric thyroid cancer. Non-White and Hispanic patients are more likely to present with larger tumors and distant disease as compared to White patients. Understanding and intervening on these SES disparities is essential to improve outcomes.