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Racial Disparities in Primary Hyperparathyroidism

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Abstract

Background

Racial disparities in surgery are increasingly recognized. We evaluated the impact of race on presentation, preoperative evaluation, and surgical outcomes for patients undergoing parathyroidectomy for primary hyperparathyroidism (PHPT).

Methods

We performed a retrospective cohort study of patients undergoing parathyroidectomy for PHPT at a single center (1997–2015). Patients were classified by self-identified race, as African-American or White. The primary outcome was disease severity at referral. The secondary outcome was completeness of preoperative evaluation. Operative success and surgical cure were evaluated.

Results

A total of 2392 patients were included. The majority of patients (87.6%) were White. African-American patients had higher rates of comorbid disease as well as higher preoperative calcium (10.9 vs.10.8 mg/dl, p < 0.001) and PTH levels (122 vs. 97 pg/ml, p < 0.001). White patients were more likely to have history of bone loss documented by DXA and nephrolithiasis. African-American patients had lower rates of complete preoperative evaluation including DXA scan. Operatively, African-American patients had larger glands by size (1.7 vs. 1.5 cm, p < 0.001) and mass (573 vs. 364 mg, p < 0.001). We observed similar operative success (98.9 vs. 98.0%, p = 0.355) and cure rates (98.3 vs. 97.0%, p = 0.756).

Conclusions

At the time of surgical referral, African-American patients with PHPT have more biochemically severe disease and higher rates of incomplete evaluation. Operative success and cure rates are comparable.

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References

  1. Yeh MW, Ituarte PH, Zhou HC et al (2013) Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 98:1122–1129

    Article  CAS  Google Scholar 

  2. Bilezikian JP, Bandeira L, Khan A et al (2018) Acute fatal hyperparathyroidism. The Lancet 391:168–178

    Article  CAS  Google Scholar 

  3. Silverberg SJ, Shane E, Jacobs TP et al (1999) A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med 341:1249–1255

    Article  CAS  Google Scholar 

  4. Rubin MR, Bilezikian JP, McMahon DJ et al (2008) The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 93:3462–3470

    Article  CAS  Google Scholar 

  5. Zanocco K, Angelos P, Sturgeon C (2006) Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism. Surgery 140:874–881

    Article  Google Scholar 

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

    Article  Google Scholar 

  7. White A, Joseph D, Rim SH et al (2017) Colon cancer survival in the United States by race and stage (2001–2009): findings from the CONCORD-2 study. Cancer 123(Suppl 24):5014–5036

    Article  Google Scholar 

  8. Carnethon MR, Pu J, Howard G et al (2017) Cardiovascular health in African Americans: a scientific statement from the American heart association. Circulation 136:e393–e423

    Article  Google Scholar 

  9. Richards TB, Henley SJ, Puckett MC et al (2017) Lung cancer survival in the United States by race and stage (2001–2009): findings from the CONCORD-2 study. Cancer 123(Suppl 24):5079–5099

    Article  Google Scholar 

  10. Montgomery SR Jr, Butler PD, Wirtalla CJ et al (2018) Racial disparities in surgical outcomes of patients with Inflammatory Bowel disease. Am J Surg 215:1046–1050

    Article  Google Scholar 

  11. Ravi P, Sood A, Schmid M et al (2015) Racial/ethnic disparities in perioperative outcomes of major procedures: results from the national surgical quality improvement program. Ann Surg 262:955–964

    Article  Google Scholar 

  12. Bowman K, Telem DA, Hernandez-Rosa J et al (2010) Impact of race and socioeconomic status on presentation and management of ventral hernias. Arch Surg 145:776–780

    Article  Google Scholar 

  13. Lassiter RL, Talukder A, Abrams MM et al (2017) Racial disparities in the use of laparoscopic surgery to treat colonic diverticulitis Are not fully explained by socioeconomics or disease complexity. Am J Surg 213:673–677

    Article  Google Scholar 

  14. Golden SH, Brown A, Cauley JA et al (2012) Health disparities in endocrine disorders: biological, clinical, and nonclinical factors–an Endocrine Society scientific statement. J Clin Endocrinol Metab 97:E1579–1639

    Article  Google Scholar 

  15. Sosa JA, Mehta PJ, Wang TS et al (2007) Racial disparities in clinical and economic outcomes from thyroidectomy. Ann Surg 246:1083–1091

    Article  Google Scholar 

  16. Noureldine SI, Abbas A, Tufano RP et al (2014) The impact of surgical volume on racial disparity in thyroid and parathyroid surgery. Ann Surg Oncol 21:2733–2739

    Article  Google Scholar 

  17. Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, Office of Management and Budget, 30 October 1997

  18. Elixhauser A, Steiner C, Harris DR et al (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  CAS  Google Scholar 

  19. Michigan Population Studies Center Institute for Social Research Zip Code Characteristics: Mean and Median Household Income. Retrieved May 21, 2020, from https://www.psc.isr.umich.edu/dis/census/Features/tract2zip/

  20. Wilhelm SM, Wang TS, Ruan DT et al (2016) The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 151:959–968

    Article  Google Scholar 

  21. Irvin GL 3rd, Dembrow VD, Prudhomme DL (1993) Clinical usefulness of an intraoperative "quick parathyroid hormone" assay. Surgery 114:1019–1022

    PubMed  Google Scholar 

  22. Mózes G, Curlee KJ, Rowland CM et al (2002) The predictive value of laboratory findings in patients with primary hyperparathyroidism. J Am Coll Surg 194:126–130

    Article  Google Scholar 

  23. Rutledge R, Stiegel M, Thomas CG Jr et al (1985) The relation of serum calcium and immunoparathormone levels to parathyroid size and weight in primary hyperparathyroidism. Surgery 98:1107–1112

    CAS  PubMed  Google Scholar 

  24. Moretz WH 3rd, Watts TL, Virgin FW Jr et al (2007) Correlation of intraoperative parathyroid hormone levels with parathyroid gland size. Laryngoscope 117:1957–1960

    Article  CAS  Google Scholar 

  25. Gorin SS, Heck JE, Cheng B et al (2006) Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med 166:2244–2252

    Article  Google Scholar 

  26. Halpern MT, Pavluck AL, Ko CY et al (2009) Factors associated with colon cancer stage at diagnosis. Dig Dis Sci 54:2680–2693

    Article  Google Scholar 

  27. Patel A, Gantz O, Zagadailov P et al (2019) The role of socioeconomic disparity in colorectal cancer stage at presentation. Updates Surg 71:523–531

    Article  Google Scholar 

  28. Kuo LE, Simmons KD, Wachtel H et al (2016) Racial disparities in Initial presentation of benign thyroid disease for resection. Ann Surg Oncol 23:2571–2576

    Article  Google Scholar 

  29. Naples R, Shin JJ, Berber E et al (2020) Recognition of primary hyperparathyroidism: delayed time course from hypercalcemia to surgery. Surgery 167:358–364

    Article  Google Scholar 

  30. Collier A, Portelli M, Ghosh S et al (2017) Primary hyperparathyroidism: Increasing prevalence, social deprivation, and surgery. Endocr Res 42:31–35

    Article  Google Scholar 

  31. Mackenbach JP, Stirbu I, Roskam AJ et al (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481

    Article  CAS  Google Scholar 

  32. Braveman P, Gottlieb L (2014) The social determinants of health: it's time to consider the causes of the causes. Public Health Rep 129(Suppl 2):19–31

    Article  Google Scholar 

Download references

Funding

HW received support from the National Center for Advancing Translational Sciences of the National Institutes of Health, Award Number KL2-TR001879.

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Silverstein Pavilion, Philadelphia, PA, 19104, USA

    Jennifer Fieber, Rachel R. Kelz, Jae P. Ermer, Chris Wirtalla, Douglas L. Fraker & Heather Wachtel

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Kristin Goodsell, Rachel R. Kelz, Douglas L. Fraker & Heather Wachtel

Authors
  1. Jennifer Fieber
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  2. Kristin Goodsell
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  3. Rachel R. Kelz
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  4. Jae P. Ermer
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  5. Chris Wirtalla
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  6. Douglas L. Fraker
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  7. Heather Wachtel
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Correspondence to Heather Wachtel.

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Fieber, J., Goodsell, K., Kelz, R.R. et al. Racial Disparities in Primary Hyperparathyroidism. World J Surg 45, 180–187 (2021). https://doi.org/10.1007/s00268-020-05791-w

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  • DOI: https://doi.org/10.1007/s00268-020-05791-w

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