(0207) Association of Insurance Status and Socioeconomic Factors in Stage II Papillary Thyroid Carcinoma

Introduction: Advanced disease in papillary thyroid carcinoma (PTC) in younger patients has significantly worse survival; therefore, it is important to examine how socioeconomic factors within this group may impact treatment patterns and survival.

Methods: A retrospective cohort analysis using the National Cancer Database was performed. We evaluated patients with stage II PTC (55 or younger with metastatic disease) diagnosed between 2004-2020. Socioeconomic and demographic included rurality, median income, and insurance status. Treatment data included facility type and treatment modalities. Overall survival (OS) was analyzed.

Results: Patients with private insurance had higher OS compared to those with government-sponsored or no insurance/unknown insurance status (p < 0.0001). Patients with private insurance were more likely to undergo radiation (71.9%) compared to those with government-sponsored (69.4%) or no insurance (56.0%, p = 0.003). Univariate analysis indicated patients with any radiation had a 26% decreased risk of mortality (CI: 0.74, HR: 0.58-0.94, p = 0.013). Kaplain-Meier analysis found significantly higher OS for patients from metro areas compared to those from urban areas (p = 0.006). On multivariable Cox Hazard regression, only government-sponsored insurance (HR 1.75 95% CI 1.19-2.57) and administration of chemotherapy (HR 5.45 95% CI 3.36-8.85) were associated with decreased survival. Race, rurality, tumor stage, margin status, and facility type were not associated significantly with survival on multivariable analysis.

Conclusions: Analyzing how factors, like insurance status, lead to differential treatment timing and outcomes will identify disparate treatment patterns and guide future efforts focused on improving access to high quality care for all.