Rural-urban Disparities in the Continuum of Thyroid Cancer Care: Analysis of 92,794 cases.

Huston-Paterson HH, Mao YV, Tseng CH, Kim J, Bobanga I, Wu JX, Yeh MW. Rural-urban Disparities in the Continuum of Thyroid Cancer Care: Analysis of 92,794 cases. Thyroid : official journal of the American Thyroid Association. 2023 Dec 19.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: Rurality is associated with higher incidence and higher disease-specific mortality for most cancers. Outcomes for rural and ultra-rural ("frontier") patients with thyroid cancer are poorly understood. This study aimed to identify actionable deficits in thyroid cancer outcomes for rural patients. METHODS: We queried linked California Cancer Registry and California Office of Statewide Health Planning and Development databases for patients diagnosed with thyroid cancer (1999-2017). We analyzed time from disease stage at diagnosis, time from diagnosis to surgery, receipt of appropriate radioactive iodine ablation, surveillance status, and overall and disease-specific mortality for urban, rural and frontier patients. Cox and logistic regression models controlled for clinical and demographic covariates a stepwise manner. All incidence figures are expressed as a proportion of newly diagnosed cases. RESULTS: Our cohort comprised 92,794 subjects: (65,475 women [70.6%]; mean age 50.0 years). Compared to urban patients, rural and frontier patients were more likely to be American Indian, White, uninsured, and from lower quintiles of socio-economic status (p < 0.01). Distant disease at diagnosis was more common in rural (56.0 vs. 50.4 cases per 1,000 new cases, p < 0.01) and frontier patients (80.9 vs. 50.4 per 1,000, p < 0.01) compared to urban patients. The incidence of medullary thyroid cancer was greater in rural patients (17.9 vs 13.6 cases per 1,000, p < 0.01) and frontier patients (31.0 vs 13.6 per 1,000, p < 0.01) compared to urban patients. The incidence of anaplastic thyroid cancer was higher in frontier vs urban patients (15.5 vs 7.1 per 1,000, p < 0.01). When compared to urban patients, rural and frontier patients were more often lost to follow-up (OR 1.69; 95% CI 1.54-1.85, and OR 3.03, 95% CI 1.89-5.26, respectively) and had higher disease-specific mortality (OR 1.18; 95% CI 1.07-1.30, and OR 1.92; 95% CI 1.22-2.77, respectively). Rural and frontier residence was independently associated with being lost to follow-up, suggesting that it is a key driver of disparities. CONCLUSION: Compared to their urban counterparts, rural and frontier patients with thyroid cancer present with later-stage disease and experience higher disease-specific mortality. They also are more often lost to follow-up, which presents an opportunity for targeted outreach to reduce the observed disparities in outcomes.