Racial disparities in the utilization of parathyroidectomy among patients with primary hyperparathyroidism: Evidence from a nationwide analysis of Medicare claims.
Racial disparities in the utilization of parathyroidectomy among patients with primary hyperparathyroidism: Evidence from a nationwide analysis of Medicare claims.
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DOI：
10.1016/j.surg.2021.05.037
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发表时间：
2022-01
期刊：
影响因子：
3.8
通讯作者：
Seib CD
中科院分区：
文献类型：
--
作者：
Alobuia WM;Meng T;Cisco RM;Lin DT;Suh I;Tamura MK;Trickey AW;Kebebew E;Seib CD
在原发性甲状旁腺功能亢进（PHPT）患者中，甲状旁腺切除术提供了治愈和减轻疾病相关并发症的机会。种族/民族对甲状旁腺切除术的转诊和应用的影响尚未得到充分探讨。基于人群的回顾性队列研究，使用2006-2016年PHPT受益人的100%医疗保险索赔。使用调整后的多变量logistic回归模型分析种族/民族与疾病严重程度、外科医生评价和随后的甲状旁腺切除术的关系。在210,206名PHPT受益人中，63,136名（30.0%）在诊断1年内接受了甲状旁腺切除术。黑人患者比其他种族/民族更有可能患有3期慢性肾病（10.8%），但骨质疏松症和肾结石的患病率较低。与白人患者相比，黑人和西班牙裔患者更有可能因phpt相关疾病住院（白人4.8%，黑人8.1%，西班牙裔5.8%;p<.001）。符合手术标准的白人患者比黑人、西班牙裔或亚洲患者更有可能行甲状旁腺切除术（白人30.5%，黑人23.0%，西班牙裔21.4%，亚洲18.7%;p< 0.001）。黑人和西班牙裔患者接受外科医生评估的调整后几率（or分别为0.71 [95%CI 0.69-0.74]、0.68 [95%CI 0.61-0.74]）和接受甲状旁腺切除术的调整后几率（or分别为0.72 [95%CI 0.68 - 0.77]、0.82 [95%CI 0.67-0.99]）较低。亚洲人种被外科医生评估的调整后几率较低（OR 0.64 [95%CI 0.57-0.71]），但甲状旁腺切除术的几率无差异。在老年人PHPT的管理中存在种族/民族差异。确定造成这种差异的因素需要迫切关注，以实现PHPT管理的平等。
Among patients with primary hyperparathyroidism (PHPT), parathyroidectomy offers a chance of cure and mitigation of disease-related complications. The impact of race/ethnicity on referral and utilization of parathyroidectomy has not been fully explored. Population-based, retrospective cohort study using 100% Medicare claims from beneficiaries with PHPT from 2006–2016. Associations of race/ethnicity with disease severity, surgeon evaluation, and subsequent parathyroidectomy were analyzed using adjusted multivariable logistic regression models. Among 210,206 beneficiaries with PHPT, 63,136 (30.0%) underwent parathyroidectomy within 1 year of diagnosis. Black patients were more likely than other race/ethnicities to have stage 3 chronic kidney disease (10.8%) but had lower prevalence of osteoporosis and nephrolithiasis. Compared to White patients, Black and Hispanic patients were more likely to have been hospitalized for PHPT-associated conditions (White 4.8%, Black 8.1%, Hispanic 5.8%; p<.001). Patients who were White and met operative criteria were more likely to undergo parathyroidectomy than Black, Hispanic or Asian patients (White 30.5%, Black 23.0%, Hispanic 21.4%, Asian 18.7%; p<.001). Black and Hispanic patients had lower adjusted odds of being evaluated by a surgeon (ORs 0.71 [95%CI 0.69–0.74], 0.68 [95%CI 0.61–0.74], respectively) and undergoing parathyroidectomy if evaluated by a surgeon (ORs 0.72 [95%CI 0.68–0.77], 0.82 [95%CI 0.67–0.99]). Asian race was associated with lower adjusted odds of being evaluated by a surgeon (OR 0.64 [95%CI 0.57–0.71]), but no difference in odds of parathyroidectomy. Racial/ethnic disparities exist in the management of PHPT among older adults. Determining the factors that account for this disparity require urgent attention to achieve parity in the management of PHPT.
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