MON-841 - Racial and Gender Disparities in the Assessment of Primary Hyperparathyroidism Among Patients with Hypercalcemia

Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by the overproduction of parathyroid hormone and hypercalcemia. Although the highest rates of PHPT are observed in Black women, Black patients are more likely to present with more advanced signs of PHPT than other demographics. Additionally, studies suggest that Black, Asian, and Hispanic patients are less likely to be evaluated by a surgeon for hyperparathyroidism or to undergo surgical treatment for PHPT. The purpose of this study is to evaluate the impact of socioeconomic and demographic factors on the evaluation of PHPT in patients with hypercalcemia.

Methodology: A retrospective analysis included electronic medical records for all patients with serum calcium values >10.3 mg/dl during a single year from 2021-2024 at the University of Rochester Medical Center. Multivariable logistic regression models determined associations between patient race, sex, Area Deprivation Index (ADI), presence of a PTH measurement, presence of PHPT diagnosis, and treatment via parathyroidectomy.

Categories under race included “Caucasian or White”, “Black or African American”, “Asian”, and “Other”. Patients who identified as Pacific Islander, American Indian or Alaskan Native were grouped into the “Other” category due to low numbers. Patients who identified as “Other”, “Unknown”, or who refused to respond were also placed under this category.

Results: A total of 103,742 patients were included in this analysis. Black/African-American race (OR 95% CI 5.5e-7–1.3e-4; p< 0.0001), Asian race (OR 95% CI 4.0e-7–4.1e-7; p< 0.0001), Other race (OR 95% CI 6.4e-8–9.9e-4; p< 0.0001) were all associated with significantly lower odds of having PTH measured following elevated serum calcium values when compared to White race. Female sex was also associated with lower odds of having PTH evaluated when compared to Male sex (OR 95% CI 0.43–0.60; p< 0.0001). The interaction effect between Other race and Female sex was found to be significant (OR 95% CI 1.8–14.9; p = 0.0009). However, no significant difference was observed regarding the effect of race, sex, or age on the odds of receiving a PHPT diagnosis or undergoing a parathyroidectomy.

Conclusion: White patients with hypercalcemia are more likely to have PTH measured than patients of other racial backgrounds. Interestingly, women, who are arguably at greater risk from the impact of PHPT due to limited bone remodeling after menopause, were less likely to have PTH measured than men, particularly women whose identified race was American Indian or Alaskan Native, Pacific Islander, or Other. Further investigation is warranted in identifying disparities in the evaluation and management of PHPT.

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