Dissecting two decades of thyroid carcinoma survival: Impact of gender, ethnicity, and income disparities.

Abstract

e18162 Background: Thyroid carcinoma is the most common endocrine malignancy, originating from follicular or parafollicular cells of the thyroid gland. It encompasses a spectrum of histological subtypes, including papillary, follicular, medullary, and anaplastic carcinomas, each with a distinct biological behavior and prognosis. Despite its generally favorable outcomes, thyroid carcinoma exhibits significant clinical variability, influenced by factors such as tumor subtype, stage at diagnosis, and patient demographics. In this study, we investigated the impact of gender, race, and socioeconomic determinants on survival outcomes in patients with thyroid carcinoma in the United States. Methods: We extracted data on patients with a diagnosis of thyroid cancer (all types) from the Surveillance Epidemiology and End Result (SEER) Registry from 2000-2021. The primary outcome of interest was cause-specific survival. According to the International Classification of Diseases for Oncology, Third Edition (ICD-O 3) system, the topography of thyroid cancer is C73.9. We excluded patients of missing or unknown income, and location. Kaplan-Meier methods were used to estimate 5-year survival rates. Cox proportional hazards regression was used for multi-variable modelling of the survival database. The difference in events between groups were analyzed using a log-rank test, with hazard ratios representing 5-year overall survival. Results: 225,121 patients met the inclusion criteria. Gender split was 55,967 males (24.86%) and 169,154 females (75.14%). Based on gender, males as compared to females have significantly worse outcomes hazard ratio was 2.2 (95% CI 2.2-2.3, p<0.001). Races were categorized into non-Hispanic (NH) Black (n=14065, 6.25%), NH White (n=144,414, 64.15%), Asian or Pacific Islander (API) (n=24551, 10.91%), Hispanic (n=38,677, 17.18%), and Alaskan-Native/American Indian (AN/AI) (n=1410, 0.63%). Compared to White patients, Black and AN/AI had significantly worse outcomes (HR 1.28, 95% CI 1.23-1.34, HR 1.25, 95% CI 1.10-1.42, p<0.001, respectively), while Hispanic and API patients had significantly improve outcomes (HR 0.78, 95% CI 0.76-0.81, HR 0.83, 95% CI 0.80-0.86, p<0.001, respectively). Compared to patients residing in urban areas (counties in metropolitan areas> 250,000 population, n=186,459), patients in rural areas had significantly worse outcomes (HR 1.4, 95% CI 1.3-1.4, p<0.001). Household income was categorized into above and below $70,000 per annum, higher household income was also associated with better outcomes (HR 0.76, 95% CI 0.74-0.78, p<0.001). Conclusions: Gender, race/ethnicity, and income disparities all played a significant role in cause-specific survival, with improved survival in females, higher household income (>$70K), Hispanic and API patients as compared to White. More efforts and research are needed to elucidate the root cause and mitigate these survival disparities .