Thyroid cancer incidence and socioeconomic indicators of health care access

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Abstract
It has been hypothesized that changes in diagnostic practices have driven the dramatic rise in thyroid cancer incidence over the past two decades. This study investigated the relation between the incidence of thyroid cancer and socioeconomic indicators of health care access. We examined thyroid cancer incidence trends in Wisconsin, USA, between 1980 and 2004, according to patient and tumor characteristics. Ecologic analyses were conducted by county to examine the relation between thyroid cancer incidence and education, income, and health insurance coverage. The incidence of thyroid cancer nearly doubled in Wisconsin between 1980 and 2004, with almost all of the increase occurring between 1990 and 2004, during which an annual change of 4.0% (95% CI: 3.3–4.6) was observed. The bulk of the increase consisted of small, localized cancers of papillary histology. Ecologic analyses indicated moderate correlations by county between thyroid cancer incidence and median household income (r = 0.25), percent of residents with a college degree (r = 0.24), and percent of residents with health insurance (r = 0.41). The association between thyroid cancer incidence and socioeconomic indicators of health care access is consistent with the hypothesis that the rising incidence trend is attributable to utilization of new diagnostic practices.