PDF(Pubmed)
Abstract：
Prior studies have demonstrated insurance-based disparities in the treatment of well-differentiated thyroid cancer. However, it remains unclear whether these disparities have persisted in the era of the 2015 American Thyroid Association (ATA) management guidelines. The goal of this study was to assess whether insurance type is associated with the receipt of guideline-concordant and timely thyroid cancer treatment in a modern cohort.
Patients diagnosed with well-differentiated thyroid cancer between 2016 and 2019 were identified from the National Cancer Database. Appropriateness of surgical and radioactive iodine treatment (RAI) was determined based on the 2015 ATA guidelines. Multivariable logistic regression and Cox proportional hazard regression analyses, stratified at age 65, were used to evaluate the associations between insurance type and appropriateness and timeliness of the treatment.
125,827 patients were included (private = 71%, Medicare = 19%, Medicaid = 10%). Compared to privately insured patients, patients with Medicaid more frequently presented with tumors >4 cm in size (11% versus 8%, P < 0.001) and regional metastases (29% versus 27%, P < 0.001). However, patients with Medicaid were also less likely to undergo appropriate surgical treatment (odds ratio 0.69, P < 0.001), less likely to undergo surgery within 90 d of diagnosis (hazard ratio 0.80, P < 0.001), and more likely to be undertreated with RAI (odds ratio 1.29, P < 0.001). There were no differences in the likelihood of guideline-concordant surgical or medical treatment by insurance type in patients ≥65 y old.
In the era of the 2015 ATA guidelines, patients with Medicaid remain less likely to receive guideline-concordant, timely surgery and more likely to be undertreated with RAI compared to privately insured patients.
Patients diagnosed with well-differentiated thyroid cancer between 2016 and 2019 were identified from the National Cancer Database. Appropriateness of surgical and radioactive iodine treatment (RAI) was determined based on the 2015 ATA guidelines. Multivariable logistic regression and Cox proportional hazard regression analyses, stratified at age 65, were used to evaluate the associations between insurance type and appropriateness and timeliness of the treatment.
125,827 patients were included (private = 71%, Medicare = 19%, Medicaid = 10%). Compared to privately insured patients, patients with Medicaid more frequently presented with tumors >4 cm in size (11% versus 8%, P < 0.001) and regional metastases (29% versus 27%, P < 0.001). However, patients with Medicaid were also less likely to undergo appropriate surgical treatment (odds ratio 0.69, P < 0.001), less likely to undergo surgery within 90 d of diagnosis (hazard ratio 0.80, P < 0.001), and more likely to be undertreated with RAI (odds ratio 1.29, P < 0.001). There were no differences in the likelihood of guideline-concordant surgical or medical treatment by insurance type in patients ≥65 y old.
In the era of the 2015 ATA guidelines, patients with Medicaid remain less likely to receive guideline-concordant, timely surgery and more likely to be undertreated with RAI compared to privately insured patients.
摘要：
背景：先前的研究表明，在高分化甲状腺癌的治疗中，基于保险的差异。然而,目前尚不清楚这些差异在2015年美国甲状腺协会(ATA)管理指南的时代是否仍然存在.这项研究的目的是评估现代队列中保险类型是否与接受指南一致和及时的甲状腺癌治疗有关。
方法：从国家癌症数据库中确定2016年至2019年诊断为高分化甲状腺癌的患者。根据2015年ATA指南确定手术和放射性碘治疗（RAI）的适当性。多变量逻辑回归和Cox比例风险回归分析，在65岁时进行分层,用于评估保险类型与治疗的适当性和及时性之间的关联.
结果：纳入125,827例患者（私人=71％，医疗保险=19%，医疗补助=10%）。与私人保险患者相比，Medicaid患者更常出现>4厘米大小的肿瘤(11%对8%，P<0.001）和区域转移（29%对27%，P<0.001)。然而,Medicaid患者也不太可能接受适当的手术治疗（比值比0.69，P<0.001），诊断后90天内手术的可能性较小(风险比0.80，P<0.001)，更有可能用RAI治疗不足（比值比1.29，P<0.001）。在≥65岁的患者中，按保险类型进行指南一致的手术或药物治疗的可能性没有差异。
结论：在2015年ATA指南的时代，医疗补助患者接受指南一致的可能性仍然较小，及时手术，与私人保险患者相比，RAI治疗不足的可能性更高。
方法：从国家癌症数据库中确定2016年至2019年诊断为高分化甲状腺癌的患者。根据2015年ATA指南确定手术和放射性碘治疗（RAI）的适当性。多变量逻辑回归和Cox比例风险回归分析，在65岁时进行分层,用于评估保险类型与治疗的适当性和及时性之间的关联.
结果：纳入125,827例患者（私人=71％，医疗保险=19%，医疗补助=10%）。与私人保险患者相比，Medicaid患者更常出现>4厘米大小的肿瘤(11%对8%，P<0.001）和区域转移（29%对27%，P<0.001)。然而,Medicaid患者也不太可能接受适当的手术治疗（比值比0.69，P<0.001），诊断后90天内手术的可能性较小(风险比0.80，P<0.001)，更有可能用RAI治疗不足（比值比1.29，P<0.001）。在≥65岁的患者中，按保险类型进行指南一致的手术或药物治疗的可能性没有差异。
结论：在2015年ATA指南的时代，医疗补助患者接受指南一致的可能性仍然较小，及时手术，与私人保险患者相比，RAI治疗不足的可能性更高。
