Impact of Neighborhood Socioeconomic Status on Presentation and Treatment of Thyroid Cancer

OBJECTIVE: We examined associations between multilevel sociodemographic factors and extent of disease at presentation and time to treatment in patients with differentiated thyroid cancer (DTC). STUDY DESIGN: Population-based study. SETTING: California Cancer Registry (CCR). METHODS: All adults diagnosed with DTC in California from January 1, 1988 to December 31, 2020 were included. Main independent variables were neighborhood socioeconomic status (nSES) and race/ethnicity. Covariates included individual sex, marital status, insurance type, and year and age at diagnosis. Primary outcomes were tumor histology, size, and stage at diagnosis. Secondary outcome was time from diagnosis to treatment. RESULTS: Among 88,894 individuals diagnosed with DTC, 77% were female, more were residents of higher SES neighborhoods (24% Q5 vs 13% Q1), and nearly half (48%) were non-Hispanic (NH) White, followed by 27% Hispanic and 7% of another NH Asian American ethnicity. In multivariable models, the odds of presenting with distant metastases were higher with lower nSES (OR Q1 vs Q5 = 1.33; 95% CI = 1.17, 1.50), male sex (OR female vs male = 0.43; 95% CI = 0.40, 0.47), and Black (OR = 1.24; 95% CI = 1.04, 1.49), Hispanic (OR = 2.02; 95% CI = 1.84, 2.21), Chinese American (OR = 1.80; 95% CI = 1.50, 2.16), Filipino American (OR = 2.07; 95% CI = 1.81, 2.36), or another Asian American (OR = 1.78; 95% CI = 1.56, 2.04) race/ethnicity. Lower nSES was associated with longer time from diagnosis to treatment (OR = 1.24; 95% CI 1.12, 1.38). CONCLUSIONS: People of lower nSES, male sex, and certain racial/ethnic groups were diagnosed with more advanced disease and had longer times to receipt of definitive treatment. Multilevel sociodemographic factors impact DTC presentation and treatment access.