Patient Neighborhood Adversity Associated With Access Not Wait Time to Parathyroidectomy.

Autor: Schears M; University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address: mschears22@gmail.com., Balentine C; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Sippel R; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Schneider D; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Elfenbein D; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Long K; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Kind A; Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Chiu A; Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Nov; Vol. 303, pp. 439-445. Date of Electronic Publication: 2024 Oct 18.
DOI: 10.1016/j.jss.2024.09.029
Abstrakt: Introduction: Delays to treatment of primary hyperparathyroidism (PHPT) escalates patient morbidity, which particularly affects individuals from under-resourced areas already facing health disparities. We hypothesized that PHPT patients from socially and economically deprived areas encounter longer waits to surgery.
Methods: Utilizing a prospectively maintained database, we identified PHPT patients aged ≥18 undergoing initial parathyroidectomy between 2013 and 2022 at an academic, tertiary care center. Patient's social and economic advantage levels were classified into deciles using the Area Deprivation Index (ADI), which accounts for 17 social determinants of health. The time from first hypercalcemic value to surgery was compared across ADI groups via linear regression, controlling for pertinent care process factors.
Results: Among 1132 patients, 68.9% were from low, 19.1% from medium, and 12.0% from high-disadvantage areas, diverging from the hospital's catchment population (55.2%, 26.6%, and 18.1%, respectively, P < 0.01). Patients from high-disadvantage areas exhibited higher comorbidity rates (55.2% versus 38.2%, P < 0.01) and were predominantly rural residents (66.2% vs. 5.8%, P < 0.01) compared to low-disadvantage areas. Similar biochemical and clinical features were shown across ADI groups. The median time from abnormal calcium to surgery was 648 d (IQR 543-753), with high-disadvantage patients experiencing a median treatment delay of 527 d, compared to 657 and 633 d for medium and low-disadvantage patients, respectively (P = 0.38). Linear regression analysis showed no association between ADI and treatment delay.
Conclusions: The high-disadvantage group underwent parathyroidectomy at lower rates than expected, but there were no significant delays in surgery among disadvantaged patients who were ultimately treated. This suggests that while social determinants may correlate to care access, they do not necessarily prolong treatment for those with established care.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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