# Regional variations in the management of primary hyperparathyroidism in Sweden: population-based case-control study

## TL;DR

This study finds that regional differences in Sweden influence how often patients with primary hyperparathyroidism undergo surgery, likely due to varying clinical practices rather than socioeconomic factors.

## Contribution

The study reveals that regional variations in parathyroidectomy rates are more likely due to differing clinical thresholds than socioeconomic disparities.

## Key findings

- Patients in regions with low parathyroidectomy rates had more severe symptoms and higher disease burden at surgery.
- Socioeconomic factors had minimal impact on surgery rates, except for lower education being slightly underrepresented.
- Annual parathyroidectomy rates varied significantly across regions in Sweden.

## Abstract

Substantial disparities in the utilization of parathyroidectomy for primary hyperparathyroidism have been reported. This study aimed to analyse regional variations in parathyroidectomy incidence with respect to the patient's disease burden and socioeconomic status.

A population-based case-control study included all patients with primary hyperparathyroidism who underwent parathyroidectomy in Sweden between 2008 and 2017 and 10 matched controls. Data on demographic and socioeconomic variables, co-morbidities and drug prescriptions were collected from relevant national registers. Conditional logistic regression was used to analyse predictors of parathyroidectomy.

A total of 8626 patients with primary hyperparathyroidism (77% women) underwent parathyroidectomy during the study interval. The annual incidence of parathyroidectomy was 9.0 per 100 000 persons. The annual age-adjusted regional incidences of parathyroidectomy varied between 3.3 and 16.9 operations per 100 000 inhabitants. Except for a small underrepresentation of patients with lower education, no effect of socioeconomic variables was observed. Compared with matched controls, the parathyroidectomy group had increased odds ratios of having developed classical symptoms of primary hyperparathyroidism and being prescribed medication against cardiovascular disorders and psychiatric illness at the time of parathyroidectomy. Increased risks of kidney stones and osteoporosis were observed 5 years before parathyroidectomy. Patients with primary hyperparathyroidism selected for parathyroidectomy from regions with a low incidence of operations had a higher prevalence of kidney stones, osteoporosis and hypertension, as well as larger adenomas and higher calcium levels at the time of parathyroidectomy compared with patients in high-incidence regions.

The considerable variation in parathyroidectomy seems more likely associated with different clinical thresholds for detection of primary hyperparathyroidism and referral to surgery than socioeconomic disparities.

A Swedish population-based case-control study on regional differences in referring patients for parathyroidectomy and socioeconomic and medical predictors of surgery.