Abstract
Background
We aimed to characterize the association between differentiated thyroid cancer (DTC)
patient insurance status and appropriateness of therapy (AOT) regarding extent of
thyroidectomy and radioactive iodine (RAI) treatment.
Methods
The National Cancer Database was queried for DTC patients diagnosed between 2010 and
2016. Adjusted odds ratios (AOR) for AOT, as defined by the American Thyroid Association
guidelines, and hazard ratios (HR) for overall survival (OS) were calculated. A difference-in-differences
(DD) analysis examined the association of Medicaid expansion with outcomes for low-income
patients aged <65.
Results
A total of 224,500 patients were included. Medicaid and uninsured patients were at
increased risk of undergoing inappropriate therapy, including inappropriate lobectomy
(Medicaid 1.36, 95% confidence interval [CI]: 1.21–1.54; uninsured 1.30, 95% CI: 1.05–1.60),
and under-treatment with RAI (Medicaid 1.20, 95% CI: 1.14–1.26; uninsured 1.44, 95%
CI: 1.33–1.55). Inappropriate lobectomy (HR 2.0, 95% CI: 1.7–2.3, P < .001) and under-treatment with RAI (HR 2.3, 95% CI: 2.2–2.5, P < .001) were independently associated with decreased survival, while appropriate
surgical resection (HR 0.3, 95% CI: 0.3–0.3, P < .001) was associated with improved odds of survival; the model controlled for all
relevant clinico-pathologic variables. No difference in AOT was observed in Medicaid
expansion versus non-expansion states with respect to surgery or adjuvant RAI therapy.
Conclusion
Medicaid and uninsured patients are at significantly increased odds of receiving inappropriate
treatment for DTC; both groups are at a survival disadvantage compared with Medicare
and those privately insured.
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Article info
Publication history
Published online: September 30, 2021
Accepted:
July 15,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
