Background: Disparities may exist in the care of patients with primary hyperparathyroidism (HPT). This study examines the presentation and outcomes of underinsured patients undergoing parathyroidectomy. Methods: We divided 493 HPT patients who underwent initial parathyroidectomy from 2000 to 2008 at a single institution into 2 groups: underinsured patients (group 1; n = 94) evaluated and treated at a county hospital, and patients with insurance (group 2; n = 399). Univariate and multivariate analysis adjusting for race and ethnicity were conducted to determine the association of being underinsured with several clinical variables. Results: More patients in group 1 compared with group 2 were of black or Hispanic background (92% vs 44%; P <.0001). Group 1 patients had higher mean preoperative serum calcium and PTH levels: 12.1 vs 11.8 mg/dL (P =.009) and 263 vs 198 pg/mL (P =.03), respectively. Seven group 1 (7.4%) and 7 group 2 (1.8%) patients presented with hypercalcemic crisis (P =.003). On multivariate analysis, underinsurance was associated with higher serum calcium levels (P =.011) and hypercalcemic crisis at presentation (odds ratio, 5.59; 95% confidence interval, 1.45-21.51; P =.012). Follow-up was shorter in group 1 patients (15 vs 24 months; P <.001) and postoperative PTH levels were higher (76 vs 48 pg/mL; P <.001). Other perioperative data were not different between the groups. Conclusion: Underinsured patients with HPT may present with higher serum calcium and PTH levels, are more likely to have hypercalcemic crisis, and less likely to return for follow-up. Underfunded health insurance coverage may account for differences seen in this study.
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