Primary hyperparathyroidism in the underinsured

A study of 493 patients

Azad A. Jabiev, John Lew, Jane L. Garb, Yamile M. Sanchez, Carmen C. Solorzano

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)471-476
Number of pages6
JournalSurgery
Volume151
Issue number3
DOIs
StatePublished - Mar 1 2012

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Primary Hyperparathyroidism
Parathyroidectomy
Hyperparathyroidism
Calcium
Multivariate Analysis
Serum
County Hospitals
Insurance Coverage
Health Insurance
Insurance
Hispanic Americans
Patient Care
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Surgery

Cite this

Jabiev, A. A., Lew, J., Garb, J. L., Sanchez, Y. M., & Solorzano, C. C. (2012). Primary hyperparathyroidism in the underinsured: A study of 493 patients. Surgery, 151(3), 471-476. https://doi.org/10.1016/j.surg.2011.07.043

Primary hyperparathyroidism in the underinsured : A study of 493 patients. / Jabiev, Azad A.; Lew, John; Garb, Jane L.; Sanchez, Yamile M.; Solorzano, Carmen C.

In: Surgery, Vol. 151, No. 3, 01.03.2012, p. 471-476.

Research output: Contribution to journalArticle

Jabiev, AA, Lew, J, Garb, JL, Sanchez, YM & Solorzano, CC 2012, 'Primary hyperparathyroidism in the underinsured: A study of 493 patients', Surgery, vol. 151, no. 3, pp. 471-476. https://doi.org/10.1016/j.surg.2011.07.043
Jabiev, Azad A. ; Lew, John ; Garb, Jane L. ; Sanchez, Yamile M. ; Solorzano, Carmen C. / Primary hyperparathyroidism in the underinsured : A study of 493 patients. In: Surgery. 2012 ; Vol. 151, No. 3. pp. 471-476.
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abstract = "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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AB - 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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