Abstract

The incidence of thyroid cancer has risen dramatically in the past few decades. The cause of this is unclear, but several lines of evidence indicate it is largely due to overdiagnosis, the diagnosis of tumors that would have never manifest clinically if untreated. Practices leading to overdiagnosis may relate to defensive medicine. In this study, we evaluated the association between malpractice climate and incidence of thyroid, breast, prostate, colon, and lung cancer in U.S. states from 1999–2012 using publicly available government data. State-level malpractice risk was quantified as malpractice payout rate, the number of malpractice payouts per 100,000 people per state per year. Associations between state-level cancer incidence, malpractice payout rate, and several cancer risk factors were evaluated. Risk factors included several social determinants of health, including factors predicting healthcare access. States with higher malpractice payout rate had higher thyroid cancer incidence, on both univariate analysis (r = 0.51, P = 0.009, Spearman) and multivariate analysis (P<0.001, multilevel model). In contrast, state-level malpractice payout rate was not associated with incidence of any other cancer type. Malpractice climate may be a social determinant for being diagnosed with thyroid cancer. This may be a product of greater defensive medicine in states with higher malpractice risk, which leads to increased diagnostic testing of patients with thyroid nodules and potential overdiagnosis. Alternatively, malpractice risk may be a proxy for another, unmeasured risk factor.

Original languageEnglish (US)
Article numbere0199862
JournalPloS one
Volume13
Issue number7
DOIs
StatePublished - Jul 1 2018

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Malpractice
Climate
Thyroid Neoplasms
climate
incidence
Incidence
neoplasms
risk factors
medicine
Defensive Medicine
Medicine
prostatic neoplasms
lung neoplasms
colorectal neoplasms
breast neoplasms
health services
multivariate analysis
Neoplasms
thyroid neoplasms
Tumors

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{01719ef6ede447249edb86469b731bff,
title = "Evidence of a positive association between malpractice climate and thyroid cancer incidence in the United States",
abstract = "The incidence of thyroid cancer has risen dramatically in the past few decades. The cause of this is unclear, but several lines of evidence indicate it is largely due to overdiagnosis, the diagnosis of tumors that would have never manifest clinically if untreated. Practices leading to overdiagnosis may relate to defensive medicine. In this study, we evaluated the association between malpractice climate and incidence of thyroid, breast, prostate, colon, and lung cancer in U.S. states from 1999–2012 using publicly available government data. State-level malpractice risk was quantified as malpractice payout rate, the number of malpractice payouts per 100,000 people per state per year. Associations between state-level cancer incidence, malpractice payout rate, and several cancer risk factors were evaluated. Risk factors included several social determinants of health, including factors predicting healthcare access. States with higher malpractice payout rate had higher thyroid cancer incidence, on both univariate analysis (r = 0.51, P = 0.009, Spearman) and multivariate analysis (P<0.001, multilevel model). In contrast, state-level malpractice payout rate was not associated with incidence of any other cancer type. Malpractice climate may be a social determinant for being diagnosed with thyroid cancer. This may be a product of greater defensive medicine in states with higher malpractice risk, which leads to increased diagnostic testing of patients with thyroid nodules and potential overdiagnosis. Alternatively, malpractice risk may be a proxy for another, unmeasured risk factor.",
author = "Brandon Labarge and Vonn Walter and Eugene Lengerich and Henry Crist and Dipti Karamchandani and Nicole Williams and David Goldenberg and Bann, {Darrin V.} and Joshua Warrick",
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T1 - Evidence of a positive association between malpractice climate and thyroid cancer incidence in the United States

AU - Labarge, Brandon

AU - Walter, Vonn

AU - Lengerich, Eugene

AU - Crist, Henry

AU - Karamchandani, Dipti

AU - Williams, Nicole

AU - Goldenberg, David

AU - Bann, Darrin V.

AU - Warrick, Joshua

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