THYROID Volume 12, Number 11, 2002 © Mary Ann Liebert, Inc. Socioeconomic Factors and the Presentation, Management, and Outcome of Patients with Differentiated Thyroid Carcinoma Farah Y. Ghori, 1 Danielle R. Gutterman-Litofsky, 1 Amin Jamal, 1 Sai-Ching J. Yeung, 1 Ridha Arem, 2 and Steven I. Sherman 1 To determine whether patients from disadvantaged socioeconomic groups present with more advanced thy- roid carcinoma or experience differing management and clinical outcomes, we retrospectively reviewed the charts of 292 patients seen at MD Anderson Cancer Center and Ben Taub General Hospital between 1987 and 1994. At diagnosis, the mean age was 42 6 16 years, 78% of patients were female, 76% of patients were low risk (TNM stage I or II), and 22% high risk (stage III or IV). Neighborhood income (6 standard error of the mean [SEM]) (1990 census data) was lower in the high-risk group compared with the low-risk group ($26,200 6 1,670 vs. $30,900 6 870, p 5 0.012). Men were more likely than women to present at an older age (47.5 6 16.7 vs. 40.2 6 16.0, p 5 0.0014) and in the high-risk group (46% vs. 15%, p , 0.0001). No socioeconomic factor (eth- nicity, marital status, occupation prestige, neighborhood income, insurance type) influenced initial diagnostic assessment. Similarly, no socioeconomic factor influenced initial disease management or the type of follow-up received over the 12-year period. Married patients had a lower 5-year recurrence rate than those unmarried (18% vs. 32%, p 5 0.03); however, this did not affect overall or disease-specific survival. Similarly, ethnicity, marital status, occupation prestige, and insurance type did not influence overall or disease-specific survival. Although 10-year overall survival rates were lower in patients in the lowest income quartile (57% vs. 70% for upper, p 5 0.0024) and in men compared with women (39% vs. 76%, p , 0.0001), gender alone influenced 10- year disease-specific survival (80% for men, 89% for women, p 5 0.047). In summary, no socioeconomic factor appears to affect initial treatment or follow-up pattern in patients with differentiated thyroid cancer. Income and gender may affect stage at initial disease presentation and may be risk factors affecting eventual clinical outcomes. 1009 Introduction D IFFERENTIATED THYROID CARCINOMAS are among the more readily treatable cancers in the human body, with a cure rate of approximately 80%–95%. They are also among the slower growing cancers, and can remain dormant for years before causing any symptoms. The most frequent reason for poor outcome in this disease is advanced age at initial pre- sentation or advanced stage of cancer. In cases of other can- cers including breast, prostate, cervical, gastric, esophageal, skin, and lung, studies have shown an association between low socioeconomic status and increased morbidity and mor- tality as a consequence of advanced stage at presentation (1–12). Similar observations have been reported with isch- emic heart disease, diabetes mellitus, and thyroid disorders such as thyrotoxicosis (13–15). In this study, we attempt to identify the influence of various indicators of socioeconomic status (ethnicity, gender, marital status, occupation prestige, neighborhood income, insurance type) on the presentation, diagnostic workup, follow-up patterns, and survival of pa- tients with differentiated thyroid carcinoma. We retrospec- tively reviewed the clinical presentation and management of 292 patients seen between 1987 and 1994. Methods Three hundred twenty-seven patients with differentiated thyroid cancer were selected for study from the University of Texas MD Anderson Cancer Center and Ben Taub Gen- eral Hospital, two tertiary referral medical centers with par- tially overlapping catchment areas. These patients presented at either institution between 1987 and 1994 with a newly di- agnosed differentiated thyroid cancer. Thirty-five patients having initial surgery prior to 1987 or having non-U.S. resi- 1 Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M.D. Anderson Cancer Center, Houston, Texas. 2 Department of Endocrinology, Baylor College of Medicine, Houston, Texas.