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Racial-Ethnic Differences of Community Vulnerability Impact on Pediatric Thyroid Cancer Diagnosis and Surveillance.
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10 authors.
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Abstract
Objective: To assess racial-ethnic differences of community-level social vulnerability impact on pediatric thyroid cancer diagnosis and surveillance. Study Design: Retrospective cohort. Setting: United States. Methods: This retrospective analysis of 4324 pediatric thyroid cancer patients diagnosed between 1975 and 2017 from the Surveillance-Epidemiology-End Results (SEER) data set assessed overall social vulnerability aggregated from 15 different social vulnerabilities of health of socioeconomic status, minority-language status, household composition, and housing-transportation from the social vulnerability index (SVI). Social vulnerability scores of each category were matched to patients across US counties. Across racial-ethnic strata (non-Hispanic-white/non-white), age-adjusted regression analyses assessed surveillance period, lymph node metastasis, and number of primary tumors with increasing social vulnerability scores. Results: For non-Hispanic-white (n = 2666) and non-white (n = 1658) pediatric thyroid cancer patients, surveillance times at the lowest and highest-total SVI levels were higher among white (162.92 and 108.02 months, respectively) compared to non-white patients (117.64; 96.96). For lymph node metastasis, increasing SVI was associated with increased occurrence among non-white pediatric thyroid cancer patients (odds ratio [OR] 1.16, 95% CI 1.05-1.27) but not among white patients (0.96, 0.89-1.03). For multiple primary tumors on presentation, no significant differences were observed across both race-ethnic groups. Conclusion: Increasing community-level social vulnerability correlated with worse pediatric thyroid cancer surveillance, especially for non-white pediatric thyroid cancer patients in diagnostic and care outcomes. Through assessing upstream and downstream effects of social vulnerability on pediatric thyroid cancer patients, this multilevel approach allows nuanced considerations of one's individual racial-ethnic identity and their community to elucidate how non-clinical factors have disproportionate effects on the diagnosis of pediatric thyroid cancers.
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