Loss of Follow-up for Thyroid Nodules in Patients Living in Poverty.

Abstract

Introduction: Inadequate surveillance of thyroid nodules can lead to cancer progression. This study examines patient characteristics that correlate with failure to follow up after thyroid nodule detection.

Methods: We performed a retrospective analysis of patients who underwent fine needle aspiration (FNA) for thyroid nodules and studied subsequent thyroid ultrasounds, clinic visits, and thyroidectomies longitudinally. Poverty areas are census tracts where at least 20% of residents live below the poverty line. Logistic regression was used to assess associations between patient characteristics and follow-ups, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Of 2446 patients included, the majority were white (62.6%) and female (78.5%), with an average age of 55 ± 16 years. 28% patients were from high poverty areas. Benign findings (Bethesda II) were observed in 73.5% of the biopsies. 42.5% of patients underwent at least one follow-up ultrasound, 59% had at least one clinic visit, and 24.4% underwent a thyroidectomy, with a 34.8% malignancy rate on surgical pathology. Patients from high poverty areas were significantly less likely to receive follow-up ultrasounds (35.7% vs. 45.9%, p < 0.001) or clinic visits (53.7% vs. 61.2%, p = 0.001). Multivariable analysis revealed that poverty was significantly associated with not having follow-up in all patients (OR = 0.78, 95% CI 0.64 - 0.96) and non-benign biopsy (Bethesda 3 or higher) results (OR = 0.44, 95% CI 0.24 - 0.81).

Conclusion: There is a notable disparity in the follow-up of thyroid nodules, with patients from high poverty areas being more susceptible to loss of follow-ups.