Background:
Several studies have described racial disparities in survival after thyroid cancer surgery. We hypothesized that assessing survival after thyroid cancer surgery in a long-term cohort with diverse gender and racial groups would reveal disparities in survival.
Methods:
We examined medical records of patients with papillary or follicular thyroid cancer thyroid surgery from 1971-2016 at a tertiary referral center. We measured survival using Kaplan-Meier estimates and Cox proportional hazards models.
Results:
From 1971 to 2016, 1440 (91%) papillary and 144 (9%) follicular thyroid cancer patients underwent total thyroidectomy (836, 53%), lobectomy (232, 15%), and other surgical procedures (516, 33%). Female were (1131, 71%), and 909 (57%). White were 805(51%), African Americans 161 (10%), and 618 (39%) other groups. Both 10-year (81.8%) and 20-year (63.5%,) survival in non-white males were worse compared to non-white females (10-year: 90.5%; 20-year: 66.0%), white males (10-year: 92.4%; 20-year: 82.3%), and white females (10-year: 95.8%, 95% CI: 94.6%-96.7%; 20-year: 90.8%, 95% CI: 87.2%-93.4%), (p<0.0001). After controlling for age, cancer type, stage, surgical procedure, radioactive iodine, and year of surgery, non-white males had a higher mortality risk compared to non-white females (HR: 1.58, 95% CI: 1.03-2.43, p=0.0376), white males (HR: 3.50, p<0.0001), and white females (HR: 4.78, p<0.0001).
Conclusion:
Our diverse cohort demonstrated significant gender and racial disparities in survival after thyroid cancer surgery. To improve health outcomes and reduce health disparities among non-white males, interventions and long-term care management should target potentially modifiable causes of worse outcomes in this group.
