Close access to health care as a bridge overcoming disparities in thyroid cancer.

INTRODUCTION

Studies occasionally demonstrate various ethnic disparities regarding differentiated thyroid cancer (DTC) characteristics and outcomes. The impact of public health care and close access to care has been studied scarcely. With a unique minority group within the hospital region, this case control study aims to investigate this further.

METHODS

A retrospective cohort study of patients with DTC diagnosis who followed-up at a tertiary medical center between 2013 and 2024. The patients were categorized into Minority (study group) or non-minority (control group) and were reviewed for DTC characteristics at presentation and outcomes including histopathology, risk of structural disease recurrence, response to initial treatment, and mortality and risk group according to the 2015 ATA guidelines [1].

RESULTS

A total of 316 patients were included, of whom 100 (31.6%) constituted the minority group. Two hundred forty-two patients (77%) were females. The minority group was diagnosed at a younger age compared to non-minority group (41 ± 15 vs. 53 ± 15 years, p < 0.001) and had higher rates of female patients (82% vs. 74%, p = 0.12, respectively). The median follow-up of the cohort was 4.41 (2.25–7.21) years. The minority cohort presented with significantly larger tumors (median 20 mm vs. 15 mm, p = 0.042) and a significantly higher prevalence of multifocality (46% vs. 31%, p = 0.03) compared to the non-minority cohort. Conversely, the rate of extrathyroidal extension (ETE) was lower in the minority cohort, although this did not reach statistical significance (21% vs. 32%, p = 0.10, respectively). DTC characteristics did not demonstrate significant differences regarding LN or distant metastasis. While the extent of surgery, ATA risk classification and response to initial therapy were comparable between the groups, the minority cohort required significantly more additional post-operative interventions (20% vs. 11%, p = 0.039). During the study period, 21 (6.6%) patients died, including 6 (1.9%) disease-specific deaths, with no between-group differences in all-cause or disease-specific mortality.

CONCLUSIONS

Our findings suggest that a good access to non-insurance based, public healthcare may reduce thyroid cancer disparities, which was reported repeatedly up to date. Health system structure and language barriers may play a role in disparities attributed to ethnicity.