- •Socioeconomic factors predispose certain populations to undergo surgery for goiter.
- •Surgery for simple goiter is more likely in the elderly, Blacks, men, and uninsured.
- •Surgery for thyroid cancer is more likely in Whites and in the Northeast.
We identified disparities and at-risk populations among patients with goiters undergoing thyroidectomy.
Materials and methods
The National Inpatient Sample (NIS) database was queried for patients with goiter who underwent thyroidectomy between 2009 and 2013. Multivariable logistic regression was used to determine factors associated with goiters undergoing thyroidectomy.
The study consisted of 103,678 patients with thyroidectomy and a goiter diagnosis, which included: simple goiter (n = 7,692, 7.42%), nodular goiter (n = 73,524, 70.92%), thyrotoxicosis (n = 14,043, 13.54%), thyroiditis (n = 1,248, 1.20%), and thyroid cancer (n = 7,169, 6.92%). Factors associated with operation for simple goiter included age >65 years (AOR 1.43 [1.15–1.79]), black race (AOR 1.35 [1.14–1.58]), and being uninsured (AOR 2.13 [1.52–2.98]). Patients with cancerous goiters undergoing thyroidectomy were less likely to be Black (AOR 0.38 [0.31–0.48]) or uninsured (AOR 0.25 [0.07–0.89]).
Understanding disparities within populations undergoing thyroidectomy for goiter may allow for targeted efforts to more effectively treat goiters nationwide.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The decade in clinical thyroid disease: an analysis of published literature.Thyroid. 2016; 26: 993-1003https://doi.org/10.1089/thy.2016.0018
- Iodine deficiency among goiter patients in rural south Sudan.BMC Res Notes. 2014; 7: 751https://doi.org/10.1186/1756-0500-7-751
- Prevalence of goiter in rural area of belgaum district, Karnataka.Indian J Community Med. 2009; 34: 48-51https://doi.org/10.4103/0970-0218.45373
- Socioeconomic factors and prevalence of endemic goitre.Indian J Public Health. 1993; 37: 48-53
- Geographic variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany.Eur J Endocrinol. 2012; 167: 363-371https://doi.org/10.1530/EJE-12-0111
- Healthcare Cost and Utilization Project, AHRQ. Overview of the National Inpatient Sample. 2015 (2018)
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Nationwide Inpatient Sample (NIS) Redesign Final Report.U.S. Agency for Healthcare Research and Quality 2014, 2014: 4 (HCUP methods series report # 2014-04)
- Thyroid disorders in women.Minerva Med. 2015; 106: 109-114
- Thyroidectomy outcomes: a national perspective.Otolaryngol Head Neck Surg. 2012; 147: 1027-1034https://doi.org/10.1177/0194599812454401
- Iodine Deficiency in Europe: A Continuing Public Health Problem.WHO/UNICEF, 2007
- Prevalence of goiter and thyroid nodules before and after implementation of the universal salt iodization program in mainland China from 1985 to 2014: a systematic review and meta-analysis.PLoS One. 2014; 9e109549https://doi.org/10.1371/journal.pone.0109549
- Association of iodized salt with goiter prevalence in Chinese populations: a continuity analysis over time.Mil Med Res. 2017; 4 (eCollection 2017): 5https://doi.org/10.1186/s40779-017-0118-5
- Association of socioeconomic status with iodine supply and thyroid disorders in northeast Germany.Thyroid. 2013; 23: 346-353https://doi.org/10.1089/thy.2012.0416
- Monitoring the effects of iodine prophylaxis in the adult population of southern Italy with deficient and sufficient iodine intake levels: a cross-sectional, epidemiological study.Br J Nutr. 2017; 117: 170-175https://doi.org/10.1017/S0007114516004499
- Iodine nutrition in the United States. trends and public health implications: iodine excretion data from national health and nutrition examination surveys I and III (1971-1974 and 1988-1994).J Clin Endocrinol Metab. 1998; 83: 3401-3408https://doi.org/10.1210/jcem.83.10.5168
- History of U.S. iodine fortification and supplementation.Nutrients. 2012; 4: 1740-1746https://doi.org/10.3390/nu4111740
- Low-iodine Diet: Preparing to Receive Radioactive Iodine.2014 (2018)
- International Classification of Diseases : [9th] Ninth Revision, Basic Tabulation List with Alphabetic Index.World Health Organization, 1978
- The natural history of euthyroid multinodular goitre.Postgrad Med J. 1990; 66: 186-190
- Graves’ disease.N Engl J Med. 2017; 376: 185https://doi.org/10.1056/NEJMc1614624
- Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): national health and nutrition examination survey (NHANES III).J Clin Endocrinol Metab. 2002; 87: 489-499https://doi.org/10.1210/jcem.87.2.8182
- Disparity in the management of graves’ disease observed at an urban county hospital: a decade-long experience.Am J Surg. 2012; 204: 199-202https://doi.org/10.1016/j.amjsurg.2011.10.010
- Chronic autoimmune thyroiditis.N Engl J Med. 1996; 335: 99-107https://doi.org/10.1056/NEJM199607113350206
- Hashimoto’s thyroiditis.World J Surg. 2008; 32: 688-692https://doi.org/10.1007/s00268-008-9485-0
- Thyroidectomy for hashimoto’s thyroiditis: complications and associated cancers.Thyroid : Off J Am Thyroid Assoc. 2008; 18: 729-734https://doi.org/10.1089/thy.2007.0384
- Racial and age-related differences in incidence and severity of focal autoimmune thyroiditis.Am J Clin Pathol. 1994; 101: 698-702https://doi.org/10.1093/ajcp/101.6.698
- Trends in thyroid cancer incidence and mortality in the United States, 1974-2013.J Am Med Assoc. 2017; 317: 1338-1348https://doi.org/10.1001/jama.2017.2719
- american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer.Thyroid 2016. 2015; 26: 1https://doi.org/10.1089/thy.2015.0020
- Systematic review of trends in the incidence rates of thyroid cancer.Thyroid. 2016; 26: 1541-1552https://doi.org/10.1089/thy.2016.0100
- Occult carcinoma of the thyroid. A systematic autopsy study from Spain of two series performed with two different methods.Cancer. 1993; 71: 4022-4029https://doi.org/10.1002/1097-0142(19930615)71:12<4022::aid-cncr2820711236>3.0.co;2-o
- Descriptive epidemiology of thyroid cancer in los angeles county, 1972-1995.Cancer Causes Control. 2000; 11: 163-170
- Cohort study of thyroid cancer in a san francisco bay area population.Int J Cancer. 2001; 93: 745-750https://doi.org/10.1002/ijc.1377
- Thyroid cancer incidence and socioeconomic indicators of health care access.Cancer Causes Control. 2008; 19: 585-593https://doi.org/10.1007/s10552-008-9122-0
- Incidence of differentiated thyroid cancer by socioeconomic status and urban residence: Canada 1991–2006.Thyroid. 2014; 24: 552-555https://doi.org/10.1089/thy.2013.0308
- The association between the socioeconomic status and thyroid cancer prevalence; based on the Korean national health and nutrition examination survey 2010-2011.J Korean Med Sci. 2013; 28: 1734https://doi.org/10.1089/thy.2013.0308
- The changing incidence of thyroid cancer.Nat Rev Endocrinol. 2016; 12: 646https://doi.org/10.1038/nrendo.2016.110
- Papillary thyroid microcarcinoma: an over-treated malignancy?.World J Surg. 2014; 38: 2297-2303https://doi.org/10.1007/s00268-014-2602-3
- Surgical management of medullary thyroid cancer: Which guidelines should we follow?.J. Laryngol. Otol. 2015; 129: 478-483https://doi.org/10.1017/S0022215115000237
- European perspective on 2015 american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: proceedings of an interactive international symposium.Thyroid. 2019; 29: 7-26https://doi.org/10.1089/thy.2017.0129
- Epidemiological and economic trends in inpatient and outpatient thyroidectomy in the United States, 1996-2006.Thyroid. 2013 Jun; 23: 727-733
- Outcomes after thyroidectomy and parathyroidectomy.Head Neck. 2012; 34: 477-484https://doi.org/10.1002/hed.21757
- Comparison of inpatient and outpatient thyroidectomy: demographic and economic disparities.Eur J Surg Oncol. 2016; 42 (1.): 1002-1008
Published online: January 08, 2020
Accepted: January 5, 2020
Received in revised form: December 26, 2019
Received: July 23, 2019
☆Abstract presented at the 13th Annual Academic Surgical Congress in Jacksonville, FL, January 30 - February 1, 2018.
© 2020 Published by Elsevier Inc.