Skip to main content

Advertisement

SpringerLink
Log in

Race and Gender Disparities in Access to Parathyroidectomy: A Need to Change Processes for Diagnosis and Referral to Surgeons

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Hyperparathyroidism substantially impairs quality of life, and effective treatment depends on timely referral to surgeons. We hypothesized that there would be race and gender disparities in the time from initial diagnosis of hyperparathyroidism to treatment with parathyroidectomy.

Methods

We reviewed administrative data on 2289 patients with hypercalcemia (calcium > 10.5 mg/dL) and abnormal parathyroid hormone levels who were seen at a tertiary referral center from 2011 to 2016. We used two-phase parametric hazard modeling to identify predictors of time from index abnormal calcium until parathyroidectomy.

Results

The median age of our cohort was 63 years, and 1685 (74%) were women. Of the total patients, 1301 (57%) were Caucasian, and 946 (41%) were African-American. Only 490 (21%) patients underwent parathyroidectomy. Among patients undergoing surgery, time from index high calcium to surgical treatment was longest for African-American men, who waited a median of 13.6 months (interquartile range IQR 2–28), compared with 2.9 months (IQR 1–8) for Caucasian males (p < 0.05). African-American women waited a median of 6.7 months (IQR 2–16) versus 3.5 months (IQR 2–14) for Caucasian women (p < 0.05). At 1 year after the index abnormal calcium, only 6% of black men underwent surgery compared with 20% of white males (p < 0.05). Similarly, 13% of black women underwent surgery versus 20% of white women (p < 0.05). These differences remained significant after adjusting for age, calcium levels, insurance, and comorbidities.

Conclusions

African-Americans face substantial delays in access to parathyroidectomy after diagnosis with hyperparathyroidism that could impair quality of life and increase health care costs. We must improve systems of diagnosis and referral to ensure timely treatment of hyperparathyroidism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Clark OH. Hyperparathyroidism. Surg Technol Int. 1991;I:291–4.

    PubMed  Google Scholar 

  2. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98(3):1122–9.

    Article  CAS  Google Scholar 

  3. Khosla S, Melton LJ, 3rd, Wermers RA, Crowson CS, O'Fallon W, Riggs B. Primary hyperparathyroidism and the risk of fracture: a population-based study. J Bone Miner Res. 1999;14(10):1700–7.

    Article  CAS  Google Scholar 

  4. Mollerup CL, Vestergaard P, Frokjaer VG, Mosekilde L, Christiansen P, Blichert-Toft M. Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study. BMJ. 2002;325(7368):807.

    Article  Google Scholar 

  5. Vestergaard P, Mollerup CL, Frokjaer VG, Christiansen P, Blichert-Toft M, Mosekilde L. Cardiovascular events before and after surgery for primary hyperparathyroidism. World J Surg. 2003;27(2):216–22.

    Article  Google Scholar 

  6. Yu N, Donnan PT, Leese GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol. 2011;75(2):169–76.

    Article  Google Scholar 

  7. Hagström E, Hellman P, Larsson TE, et al. Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation. 2009;119(21):2765–71.

    Article  Google Scholar 

  8. Zanocco KA, Wu JX, Yeh MW. Parathyroidectomy for asymptomatic primary hyperparathyroidism: a revised cost-effectiveness analysis incorporating fracture risk reduction. Surgery. 2017;161(1):16–24.

    Article  Google Scholar 

  9. Lou I, Balentine C, Clarkson S, Schneider DF, Sippel RS, Chen H. How long should we follow patients after apparently curative parathyroidectomy? Surgery. 2017;161(1):54–61.

    Article  Google Scholar 

  10. Balentine CJ, Xie R, Kirklin JK, Chen H. Failure to diagnose hyperparathyroidism in 10,432 patients with hypercalcemia: opportunities for system-level intervention to increase surgical referrals and cure. Ann Surg. 2017;266(4):632–40.

    Article  Google Scholar 

  11. Press DM, Siperstein AE, Berber E, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013;154(6):1232–7; discussion 1237–8.

  12. Wu JX, Yeh MW. Asymptomatic primary hyperparathyroidism: diagnostic pitfalls and surgical intervention. Surg Oncol Clin N Am. 2016;25(1):77–90.

    Article  Google Scholar 

  13. Alore EA, Suliburk JW, Ramsey DJ, et. al. Diagnosis and management of primary hyperparathyroidism across the veterans affairs health care system. JAMA Internal Med. 2019. https://doi.org/10.1001/jamainternmed.2019.1747

    Article  Google Scholar 

  14. Eley JW, Hill HA, Chen VW, et al. Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. JAMA. 1994;272(12):947–54.

    Article  CAS  Google Scholar 

  15. Bach PB, Schrag D, Brawley OW, Galaznik A, Yakren S, Begg CB. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002;287(16):2106–13.

    Article  Google Scholar 

  16. Jolly S, Vittinghoff E, Chattopadhyay A, Bibbins-Domingo K. Higher cardiovascular disease prevalence and mortality among younger blacks compared to whites. Am J Med. 2010;123(9):811–8.

    Article  Google Scholar 

  17. Liff JM, Chow WH, Greenberg RS. Rural-urban differences in stage at diagnosis. Possible relationship to cancer screening. Cancer. 1991;67(5):1454–9.

    Article  CAS  Google Scholar 

  18. Chow CJ, Al-Refaie WB, Abraham A, et al. Does patient rurality predict quality colon cancer care?: A population-based study. Dis Colon Rectum. 2015;58(4):415–22.

    Article  Google Scholar 

  19. Schroder SL, Richter M, Schroder J, Frantz S, Fink A. Socioeconomic inequalities in access to treatment for coronary heart disease: a systematic review. Int J Cardiol. 2016;219:70–8.

    Article  Google Scholar 

  20. Clark AM, DesMeules M, Luo W, Duncan AS, Wielgosz A. Socioeconomic status and cardiovascular disease: risks and implications for care. Nat Rev Cardiol. 2009;6(11):712–22.

    Article  Google Scholar 

  21. Katz SJ, Hofer TP. Socioeconomic disparities in preventive care persist despite universal coverage. Breast and cervical cancer screening in Ontario and the United States. JAMA. 1994;272(7):530–4.

    Article  CAS  Google Scholar 

  22. Sosa JA, Mehta PJ, Wang TS, Yeo HL, Roman SA. Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg. 2007;246(6):1083–91.

    Article  Google Scholar 

  23. Shah SA, Adam MA, Thomas SM, et al. Racial disparities in differentiated thyroid cancer: have we bridged the gap? Thyroid. 2017;27(6):762–72.

    Article  CAS  Google Scholar 

  24. Golden SH, Brown A, Cauley JA, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors—an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2012;97(9):E1579–39.

    Article  Google Scholar 

  25. Al-Qurayshi Z, Randolph GW, Srivastav S, Aslam R, Friedlander P, Kandil E. Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope. 2016;126(9):2194–9.

    Article  Google Scholar 

  26. Noureldine SI, Abbas A, Tufano RP, et al. The impact of surgical volume on racial disparity in thyroid and parathyroid surgery. Ann Surg Oncol. 2014;21(8):2733–9.

    Article  Google Scholar 

  27. Jang S, Mandabach M, Aburjania Z, Balentine CJ, Chen H. Racial disparities in the cost of surgical care for parathyroidectomy. J Surg Res. 2018;221:216–21.

    Article  Google Scholar 

  28. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.

    Article  CAS  Google Scholar 

  29. Blackstone EH, Naftel DC, Turner ME. The decomposition of time-varying hazard into phases, each incorporating a separate stream of concomitant information. J Am Stat Assoc. 1986;81(395):615–24.

    Article  Google Scholar 

  30. Jones DJ, Crump AD, Lloyd JJ. Health disparities in boys and men of color. Am J Public Health. 2012;102(Suppl 2):S170–2.

    Article  Google Scholar 

  31. Lurie N, Dubowitz T. Health disparities and access to health. JAMA. 2007;297(10):1118–21.

    Article  CAS  Google Scholar 

  32. Hargraves JL. Trends in health insurance coverage and access among black, Latino and white Americans, 2001–2003. Track Rep. 2004(11):1–6.

    Google Scholar 

  33. Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Med Care Res Rev. 2000;57(Suppl 1):11–35.

    Article  Google Scholar 

  34. Eisenberg JM, Power EJ. Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality. JAMA. 2000;284(16):2100–7.

    Article  CAS  Google Scholar 

  35. Ali NM, Combs RM, Muvuka B, Ayangeakaa SD. Addressing health insurance literacy gaps in an urban African American population: a qualitative study. J Community Health. 2018;43(6):1208–16

    Article  Google Scholar 

  36. Osborn CY, Cavanaugh K, Wallston KA, et al. Health literacy explains racial disparities in diabetes medication adherence. J Health Commun. 2011;16(Suppl 3):268–78.

    Article  Google Scholar 

  37. Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005;165(17):1946–52.

    Article  Google Scholar 

  38. Probst JC, Laditka SB, Wang JY, Johnson AO. Effects of residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel Survey. BMC Health Serv Res. 2007;7:40.

    Article  Google Scholar 

  39. Taber JM, Leyva B, Persoskie A. Why do people avoid medical care? A qualitative study using national data. J Gen Intern Med. 2015;30(3):290–7.

    Article  Google Scholar 

  40. Eiser AR, Ellis G. Viewpoint: cultural competence and the African American experience with health care: the case for specific content in cross-cultural education. Acad Med. 2007;82(2):176–83.

    Article  Google Scholar 

Download references

Acknowledgment

CB was supported by a GEMSSTAR R03 (1R03AG056330-01) grant from the National Institute on Aging and a K12 grant (K12 HS023009-03) from the Agency for Health Research and Quality.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Reema Mallick MD

  2. Department of Surgery, University of Alabama-Birmingham, Birmingham, AL, USA

    Rongbing Xie DrPH, MPH, James K. Kirklin MD & Herbert Chen MD

  3. Kirklin Institute for Research in Surgical Outcomes, University of Alabama-Birmingham, Birmingham, AL, USA

    Rongbing Xie DrPH, MPH & James K. Kirklin MD

  4. North Texas VA Health Care System, Dallas, TX, USA

    Courtney J. Balentine MD, MPH

  5. Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Courtney J. Balentine MD, MPH

Authors
  1. Reema Mallick MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rongbing Xie DrPH, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James K. Kirklin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Herbert Chen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Courtney J. Balentine MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Courtney J. Balentine MD, MPH.

Ethics declarations

Disclosures

All authors acknowledge no conflict of interest with respect to this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mallick, R., Xie, R., Kirklin, J.K. et al. Race and Gender Disparities in Access to Parathyroidectomy: A Need to Change Processes for Diagnosis and Referral to Surgeons. Ann Surg Oncol 28, 476–483 (2021). https://doi.org/10.1245/s10434-020-08707-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08707-z

Search

Navigation