Sociodemographic Disparities in the Treatment of Hypothyroidism: NHANES 2007-2012

Purpose: Both undertreatment and overtreatment of hypothyroidism with thyroid hormone are associated with adverse clinical outcomes. Disparities in the treatment of hypothyroidism may lead to a higher risk of adverse outcomes for certain sociodemographic groups. Our objectives were to identify sociodemographic disparities between those with treated and untreated hypothyroidism, and between those who were adequately and inadequately treated. Methods: This is a cross-sectional study of a representative sample of US adults aged 20 years and older with hypothyroidism (n = 698). The main measures were age, gender, race/ethnicity, education, income, and health care access differences among those with treated and untreated hypothyroidism. Results: Of those with hypothyroidism, women were more likely than men to be taking thyroid hormone (odds ratio [OR] 2.66 [95% confidence interval (CI) 1.42-4.99]), as were older participants (45-69 years old vs 20-44 years old: OR 7.25 [95% CI 4.15-12.67]; 70 years of age and older: OR 11.00 [95% CI 5.30-22.79]). Health care access was strongly associated with thyroid hormone use (OR 14.32, 95% CI 3.63-56.58). Hispanic race/ethnicity was associated with inadequate treatment compared with non-Hispanic whites (OR 2.42, 95% CI: 1.14-5.14). Main Conclusions: Male gender, younger age, and lack of health care access were associated with untreated hypothyroidism, and Hispanic race was associated with inadequate treatment of hypothyroidism. Clinicians should be aware of these sociodemographic disparities in the hypothyroid population and consider strategies to improve treatment of hypothyroidism in men, younger adults, Hispanics, and those without routine health care access.