Year: 2024
Type: article
Study design: Observational Study
Abstract: Y.B. Omotosho: None. R. McGlotten: None. P. Chittiboina: None. L. Nieman: None. Background: Early recognition and treatment of Cushing’s syndrome (CS) is important to reduce mortality, forestall additional co-morbidities, and improve long-term quality of life. Little is known about how adverse social determinants of health (SDOH) influence the achievement of this goal.Objective: To investigate the impact of race (Black vs White) and UFC on the time to definitive diagnosis and treatment of Cushing’s disease (CD).Methods: This is a retrospective cohort study of 114 patients (pts) (including all Non-Hispanic Blacks) evaluated at the National Institutes of Health between 1990-2022, who had CD based on pathology (ACTH-positive tumor immunohistochemistry) or biochemical remission after transsphenoidal surgery (TSS). 38 Non-Hispanic Black patients met entry criteria. They were matched 1:2 by age (within five years) and sex. We excluded patients with cyclic CS, recurrent CD, previous pituitary surgery or radiation therapy and/or a delay between diagnostic evaluation and surgery of more than 4 weeks. We limited cohorts to only Non-Hispanic Blacks and Whites for this pilot study and plan to extend this to smaller race/ethnicity groups in the future. The onset of clinical symptoms was documented as self-reported by the patients. We analyzed the difference between the year of symptom onset and the date TSS was performed, to obtain an estimated duration of diagnosis. The highest 24h urine cortisol (UFC) value for each patient was noted. Non-normal data are described as median [interquartile range]. Group comparisons used the Wilcoxon rank sum test for the time to etiologic diagnosis, age, and UFC. Statistical analyses were done using R/RStudio statistical software. P value <0.05 was considered significant. Results: Each racial group included 76.3% females and 23.7% males. The median age at TSS was 39.5 years [30.0 – 50.8] for Blacks and 41.5 years [31.8 - 53.3] for Whites (P= 0.7). The median UFC was 326 mcg/24h [156 - 491] for Blacks and 264 [166 - 609] for Whites (P= 0.8). The median duration from symptom onset to CD diagnosis was 3.67 years [2.76 - 6.29] for Blacks and for 2.56 years [1.57 - 4.13] for Whites. Analysis of the differences in time to diagnosis between both groups confirmed a significant disparity with blacks having a median delay of 1.1 years more than whites (P= 0.001). Discussion: We do not have information on other SDOH in our patients, such as access to providers, education level, or their perception of the medical community. The present data suggest that racial background serves as a limiting factor in the diagnosis and differential diagnosis of CS, and that differences in severity of hypercortisolism do not explain this disparity. More work is needed to understand the reasons for this disparity as we continue to strive towards health equity. Monday, June 3, 2024
Source: Journal of the Endocrine Society
Authors: Y B Omotosho, R McGlotten, P Chittiboina, L Nieman
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,418
OpenAlex ID: W4409965270