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Data Mining for Racial, Gender, and Social Economic Status Disparities in Thyroid Cancer. Sylvia Le April 29, 2010. Disparities in Health Care. Disparities in health care have serious impact on the quality of health care. - PowerPoint PPT Presentation
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Data Mining for Racial, Gender, and
Social Economic Status Disparities
in Thyroid CancerSylvia Le
April 29, 2010
Disparities in Health CareDisparities in health care have serious impact
on the quality of health care.
Identifying health disparities may seem difficult at times, but recognition is essential.
Data mining has been used to effectively recognize several disparities in different areas of health care.
The ThyroidThe thyroid is an endocrine gland
(hormone secreting and producing organ) located anterior to the trachea.
This organ secretes hormones thyroxine (T4) and triiodothyronnine (T3) which help regulate metabolism and growth.
Thyroid cancer can occur at any age, and there are over 20,000 new cases of thyroid cancer every year.
Purpose
Are there race, gender, and socioeconomic
disparities affecting treatment and survival for
thyroid cancer patients?
SEER for Data MiningSurveillance, Epidemiology and End Results
(SEER) program of the National Cancer Institute is the data and software source for this data mining process.
Software: SEER*Stat 6.5.2
Dataset: Incidence - SEER 17 Regs Limited-Use + Hurricane Katrina Impacted Louisiana Cases, Nov 2009 Sub (2000-2007) <Katrina/Rita Population Adjustment>
Data Selection Only Thyroid cancer patients
from Variable Set {Site and Morphology. Site rec with Kaposi and mesothelioma}
where there exists known data for Race - White, Black, American Indian/Alaska Native, Asian/Pacific Islander,
Non-white Hispanic Sex – Male, Female Age - 00 - 85+ years
To limit data size and ensure the more recent information is used, only patients diagnosed from 2000 - 2006 will be used.
Information about socioeconomic status (SES) is not directly available from the patients but rather this data is calculated from US Census data by County. This variable was formed into Quintiles based on Median Household Income.
Total number of patients = 47,278.
Data Mining for Survival Disparities
Compare variables to Survival time in 6-month intervals (000-083 months)
Used SEER*Stat Frequency Session to calculate Count and Frequency (Column%)
Exported tables to .txt and visualized using Excel graphs
Survival Time vs SexCount
Observe Sex Ratio in these two kinds of stacked bar graphs.
Females make up ~75% of the thyroid cancer patients.
612182430364248546066727883
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
MaleFemale
Surv
ival
Tim
e (m
onth
s)
6
18
30
42
54
66
78
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000
Number of Patients
Surv
ival
Tim
e (m
onth
s)
Survival Time vs SexFrequency
Observe that survival time has rapid decrease in the first year after diagnosis.
The two survival curves do not seem to indicate a disparity between male and female survival.
6 12 18 24 30 36 42 48 54 60 66 72 78 830.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%
MaleFemale
Survival Time (months)
Freq
uenc
y (%
)
Survival Time vs RaceCount
Observe Rate Ratio in these two kinds of stacked bar graphs.
Notice whites make up ~70% of the patients.
6
18
30
42
54
66
78
0 2,000 4,000 6,000 8,000
WhiteBlackAmerIndAsia/PacHispan
Number of Patients
Surv
ival
Tim
e (m
onth
s)
6
18
30
42
54
66
78
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Surv
ival
Tim
e (m
onth
s)
Survival Time vs RaceFrequencyThe five survival curves do not seem to indicate a disparity
between races in survival.American Indian/Alaska Native have a few unusual blips
probably because their patient population is very low, making the curve susceptible to such increases/decreases.
6 12 18 24 30 36 42 48 54 60 66 72 78 830.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%
WhiteBlackAmerIndAsia/PacHispan
Survival Time (months)
Freq
uenc
y (%
)
Survival Time vs SESCountObserve Quintile Ratio in these two kinds of
stacked bar graphs.Notice Third and Fourth Quintile make up
~40% and ~55% of total number of patients.
6
18
30
42
54
66
78
0 10002000300040005000600070008000
First Quintile - LowestSecond QuintileThird QuintileFourth QuintileFifth Quintile - Highest
Number of Patients
Surv
ival
Tim
e (m
onth
s)
6
18
30
42
54
66
78
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Surv
ival
Tim
e (m
onth
s)
Survival vs SESFrequencyThe five survival curves do not seem to indicate a disparity
between socioeconomic status and survival. The Second Quintile has a few unusual blips for similar reasons as
Native American/Alaska Native did for previous frequency graph; the patient count for this groups is very low.
6 12 18 24 30 36 42 48 54 60 66 72 78 830%
2%
4%
6%
8%
10%
12%
14%
16%
18%
First Quintile - LowestSecond QuintileThird QuintileFourth QuintileFifth Quintile - Highest
Survival Time (months)
Freq
uenc
y (%
)
Treatment vs SexCountObserve Sex Ratio in these two kinds of
stacked bar graphs.Notice that the fraction of females is still
greater, but less clear for each treatment.
No Surgery, patient died before recommended surgery
Radiation before and after Surgery
Radiation before Surgery
No Surgery, Recommended but no perform for unknown reasons
Radiation after Surgery
0 10000 20000 30000
Number of Patients
Trea
tmen
t
0% 20%
40%
60%
80%
100%
MaleFemale
Trea
tmen
t
Treatment vs SexFrequencyBecause proportion of Radiation before and after
Treatment is so large, it was removed to form the graph on the right so view other treatment graphs.
Females appear to have less Intraoperative Radiation and Males tend to not have recommended surgeries.
No Surgery, patient died before recommended surgeryIntraoperative Radiation
Radiation before and after Surgery
No Surgery, Recommended but patient refused
Radiation before SurgeryNo Surgery, Constraindicated due to other conditions
No Surgery, Recommended but no perform for unknown reasons
No Surgery, Not recommended
Radiation after Surgery
0.00%
50.00%
100.00%
MaleFemale
Intraoperative Radiation
Radiation before and after Surgery
No Surgery, Recommended but patient refused
Radiation before Surgery
No Surgery, Constraindicated due to other conditions
No Surgery, Recommended but no perform for unknown reasons
No Surgery, Not recommended
Radiation after Surgery
0.00%
5.00%
10.00%
Treatment vs RaceCountObserve Race Ratios in these two kinds of
stacked bar graphs.Notice that the fraction of whites is still
greater, but less clear for each treatment.
No Surgery, patient died before recommended surgery
Radiation before and after Surgery
Radiation before Surgery
No Surgery, Recommended but no perform for unknown reasons
Radiation after Surgery
0 10000 20000 30000
WhiteBlackAmerIndAsia/PacHispan
Number of Patients
Trea
tmen
t
0% 20% 40% 60% 80% 100%Tr
eatm
ent
Treatment vs RaceFrequency Because proportion of Radiation before and after Treatment is so
large, it was removed to form the graph on the right so view other treatment graphs.
Several disparities seem to appear: Blacks seem to have the most non-recommended surgeries. American Indian/Alaska Natives most frequently seem to have
no surgery due to patient refusal or other constraints..
Rad after SurgNo Surg, Not recommend
No Surg, Rec but no perform
No Surg, Constrain other
Rad before SurgNo Surg, Rec but Pt refuse
Rad before and after Surg
Intraoperative Rad
No Surg, Pt died before
0.00%
50.00%
100.00%
WhiteBlackAmerIndAsia/PacHispan
Intraoperative RadiationRadiation before and after Surgery
No Surgery, Recommended but patient refused
Radiation before SurgeryNo Surgery, Constraindicated due to other conditions
No Surgery, Recommended but no perform for unknown reasons
No Surgery, Not recommended
Radiation after Surgery
0.00%
5.00%
10.00%
Treatment vs SESCountObserve Quintile Ratio in these two kinds of stacked
bar graphs.Notice that Third and Fourth Quintile still make up
the majority of patients, but fraction is less clear that in Survival set.
Notice also that Radiation before and after Surgery treatment makes up ~90% of all treatment counts.
No Surgery, patient died before recommended surgery
Radiation before and after Surgery
Radiation before Surgery
No Surgery, Recommended but no perform for unknown reasons
Radiation after Surgery
0 5000 10000 15000 20000 25000Number of Patients
Trea
tmen
t
0% 20% 40% 60% 80% 100%
First Quintile - LowestSecond QuintileThird QuintileFourth QuintileFifth Quintile - Highest
Trea
tmen
t
Treatment vs SESFrequencyBecause proportion of Radiation before and after
Treatment is so large, it was removed to form the graph on the right so view other treatment graphs.
Radar graphs do not seem to indicate disparity in treatment based on socioeconomic status.
No Surgery, patient died before recommended surgeryIntraoperative Radiation
Radiation before and after Surgery
No Surgery, Recommended but patient refused
Radiation before SurgeryNo Surgery, Constraindicated due to other conditions
No Surgery, Recommended but no perform for unknown reasons
No Surgery, Not recommended
Radiation after Surgery
0%
50%
100%First Quintile - LowestSecond QuintileThird QuintileFourth QuintileFifth Quintile - Highest
Intraoperative RadiationRadiation before and after Surgery
No Surgery, Recommended but patient refused
Radiation before SurgeryNo Surgery, Constraindicated due to other conditions
No Surgery, Recommended but no perform for unknown reasons
No Surgery, Not recommended
Radiation after Surgery
0%
5%
10%
ConclusionsNone of Race, Gender or Socioeconomic
Status appear to have Survival disparities.
However, several disparities can be observed with patient Treatment for Race and Gender.
Treatment does not seem to have as significant of disparities for Socioeconomic Status.
Questions?