FRI514 Treatment Of Hypothyroidism By Age And Sex In The United States: A National Health And Nutrition Examination Survey (NHANES) And Optum Claims Data Analysis
Authors: Tessnow Alex , Wyne Kathleen L , Patrick Schneiderman Chris , Pinsky Brett , Guo Dianlin , Barger Bruce , Antunez Flores Oscar 
Published: October 2023

Abstract
Disclosure: A. Tessnow: None. K.L. Wyne: None. C.P. Schneiderman: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. B. Pinsky: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. D. Guo: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. B. Barger: Employee; Self; Abbvie. Stock Owner; Self; Abbvie. O. Antunez Flores: Employee; Self; Abbvie. Stock Owner; Self; Abbvie.
Background: Recently updated hypothyroidism (HT) prevalence in the United States (US) using NHANES and Optum Claims data (OCD) showed an increasing prevalence of overall HT from 9.6% in 2012 to 11.7% in 2019. Objectives: Characterize treatment pattern of overt HT (OHT) in the US with NHANES 2009-12 cycles and OCD during 2019. Methods: Combined NHANES Survey data from the 2009-12 cycles and OCD for 2019 were utilized. Patients age ≥12 years old were included in the NHANES thyroid profile sub-sample; for Optum patients ≥18 were included and women who were pregnant were excluded. Disease status was determined from blood samples (NHANES), labs (OCD) or evidence of HT Tx. OHT was defined as presence of elevated thyroid-stimulating hormone (TSH &gt;4.0 mIU/L) and a subnormal or low level of free thyroxine (FT4 &lt; 0.8 ng/dL); patients with a documented prescription (Rx) for HT Tx with levothyroxine or liothyronine were also categorized with OHT regardless of lab values. The results were stratified by age (12/18-44, 45-59, 60+) and sex, concurrently. NHANES data was further stratified by insurance status (private or Medicare vs neither) and excluded sub-clinical HT to parallel OCD estimates. Results: Among both the OCD and matched NHANES cohorts, overall Tx of OHT was 83.6% & 79.5% respectively. The OCD cohort showed both males and females having similar Tx patterns across age and sex strata, ranging from 78.6% of males aged 60+ with evidence of Rx, to 91.3% of females aged 45-59. Among NHANES strata, overall Tx rates increased as age increases (ages 12-44 = 62% to 60+ = 87.5%) and higher in females than in males, especially among those aged 60+ years (ages 12-44 F:M; 66.2% - 53.2%, ages 45-59; 81.3% - 71.1%, and 60+; 93.7% - 67.0%). Sex differences were less pronounced, and the Tx rates tend to be lower among those aged 60+ years in OCD analysis (ages 18-44 F:M; 90.1% - 85.7%, ages 45-59; 91.3% - 87.8%, and 60+; 82.0% - 78.6%). Among the NHANES strata not privately or Medicare insured, OHT Tx rates overall were 55.9%, with younger females and males &lt; 60 years old showing the lowest treatment rates (M 12-44 - 0% F 12-44 - 30%). Study Limitations: Claims data may incompletely capture the conditions and outcomes documented in the medical records and prevalence may be overestimated due to miss or rule out coding. The active surveillance of thyroid function conducted in NHANES might also have contributed to the differences. Likewise, NHANES may overestimate OHT as no re-testing occurs for thyroid function. Conclusions: This study provides important updates to the treatment of HT by age-groups and sex using both total and insured population estimates. Differences between NHANES and OCD Tx patterns may be due to the population-based approach of NHANES compared to care-seeking behavior as observed in claims data. Further analyses to delineate treatment patterns by age & sex will be completed to better understand the treated and untreated population.
Presentation: Friday, June 16, 2023