S. Jang1,2, C. J. Balentine1, H. Chen1 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA 2Howard Hughes Medical Institute,Chevy Chase, MD, USA
Introduction: Racial disparities in health care and health outcomes have been well documented in most diseases, but there is limited data for thyroid disease. Thyroidectomy is the mainstay for many thyroid diseases, but its cost among different racial and ethnic groups are largely unexamined. The purpose of this study was to examine the association between race and ethnicity and the total hospital cost of thyroidectomy.
Methods: This retrospective study included 898 consecutive cases in our institution between September 2011 and July 2016 coded as complete thyroidectomy or total thyroidectomy using ICD-9 and 10 procedure codes. We evaluated demographics, insurance type, and readmission rates. Total length of stay and hospital costs were evaluated using the Mann-Whitney U and the Kruskal-Wallis non-parametric tests. Categorical variables were evaluated with chi-square. Distributions are denoted by standard error of the mean.
Results: The study population was 64.0% Caucasian, 33.2% African American, 0.8% Hispanic, and 0.5% Asian. Median age was 48 years, 81% were female, and 77% were outpatients. Blue Cross was the most common payer type (50%). Total hospital costs were greater for African American patients ($6,750.23 ± 372.15, p<0.001) compared to Caucasian patients ($5,890.87 ± 233.96) but not for Hispanic and Asian patients. Compared to Caucasian patients, African American patients were more likely to experience hospital costs greater than $10,000 (9.1% vs 4.7%, P = 0.007), and the difference in total cost was still significant even after the exclusion of cases that cost above $10,000. Mean length of stay was 1.61d ± 0.20 for African American patients while it was 0.93d ± 0.07 for Caucasian patients (P <0.001), where 71% and 54% were discharged on the same day, respectively (p<0.001). Nevertheless, there were no difference in readmission rate between African American and Caucasian patients (P = 0.958). Additionally, African American and Caucasian males had higher costs (p<0.001 and trending at 0.054, respectively) and longer length of stay (p<0.001 and 0.047, respectively) compared to their racial counterparts. Comparing specific costs across the four groups showed that African American males had the highest cost of anesthesiology (P=0.001) and Caucasian females had the lowest cost of labs (p<0.001). There were no difference in cost of radiology and heart center across the groups (p=0.078 and 0.558, respectively).
Conclusion: African American race was associated with higher hospital costs for thyroidectomy compared to Caucasian patients. The increased cost could be explained in part by longer length of stays after the operation. Thyroidectomies done on male patients were more costly compared to their female racial counterparts. Examining specific areas of racial disparity in surgical cost is a potent method of addressing economic and social inequality and can potentially reduce cost of health care.