Surgical disparities among patients with primary hyperparathyroidism: a national inpatient sample database study

Abstract

Socioeconomic and racial disparities in access to medical care have been shown to impact the morbidity and mortality of patients with surgically managed conditions. Primary Hyperparathyroidism (PHPT) is cured only by parathyroidectomy. Limited data exists examining the role of racial and socioeconomic disparity on surgical referral. Patients carrying a diagnosis of PHPT between the years of 2000–2017 were identified through the National Inpatient Sample (NIS) database. A Chi Square analysis was used to compare categorical variables and a logistic regression model with odds ratios was used to identify social predictors of surgical management. Only patients with APR-DRG Severity of Illness classifications of mild/moderate were included in the analysis, excluding patients with severe comorbidities precluding surgery. 78,520 patients were included. 75% were female. 14% were Black and 6% were Hispanic. 77% underwent parathyroidectomy. In this analysis, no statistically significant difference in odds of surgery was observed in White vs. Black patients. Hispanic patients were more likely to undergo operation than White patients (OR 1.22 [1.02–1.47] p < 0.05). Income quartile did not affect odds of surgery. Patients with private insurance were significantly more likely to be surgically managed when compared to Medicaid patients (1.40 [1.15–1.72] p < 0.001). A subgroup analysis of patients <50 years old, all of whom met National Institute of Health criteria for parathyroidectomy, was performed. Of these patients, privately insured patients were significantly more likely to undergo surgery than Medicaid patients (1.50 [1.10–2.04] p < 0.05). No statistically significant difference in odds of operation was observed between racial categories in this subgroup analysis. Patients in the highest income quartile had an increased odds of surgery when compared to patients in the lowest income quartile (OR 1.47 [1.10–1.97] p < 0.001). In patients diagnosed with PHPT, being privately insured with income in the highest quartile were factors predictive of undergoing operation for PHPT. Therefore, it is expected that patients who are on Medicaid and in the lowest income quartile would be more likely to develop the morbidities associated with advanced primary hyperparathyroidism.