Abstract
Background
A majority of patients with primary hyperparathyroidism are not referred for surgical
evaluation. We hypothesized that disparities in the rate of surgeon evaluation by
language, race and ethnicity, and insurance contribute to this deficit.
Methods
We queried our institutional electronic health record registry for patients with first-incident
hypercalcemia between 2010 and 2018 and subsequent biochemical diagnosis of primary
hyperparathyroidism. We used the Kaplan-Meier method and Cox proportional hazards
modeling to investigate estimated time to surgeon evaluation by language, race and
ethnicity, and insurance status.
Results
Of 1,333 patients with a diagnosis of primary hyperparathyroidism, 74% were female,
67% were White, 44% were privately insured, and 88% preferred English. Fewer than
one third (n = 377; 28%) were evaluated by a surgeon. After adjusting for demographic
and clinical factors, Asian (hazard ratio = 0.38; 95% confidence interval, 0.18–0.84;
P = .016) and Black or African American patients (hazard ratio = 0.59; 95% confidence
interval, 0.39–0.90; P = .014) had a lower rate of surgeon evaluation compared to White patients. Although
patients with Medicaid had a lower rate of surgeon evaluation compared to privately
insured patients (hazard ratio = 0.52; 95% confidence interval, 0.35–0.77; P = .001), there was no difference in rate for those with Medicare or who were uninsured.
Patients with non-English and non-Spanish language had a lower rate of evaluation
compared to those who preferred English (hazard ratio = 0.47; 95% confidence interval,
0.23–0.98; P = .043).
Conclusion
Rates of surgeon evaluation vary by race and ethnicity, insurance status, and preferred
language. Evaluation of factors contributing to these disparities is needed to improve
access to surgeon referral.
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Article info
Publication history
Published online: October 02, 2022
Accepted:
June 14,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
