Class of 2013 Abstract / Specific Aims: To assess associations between clinical and economic outcomes of metastatic thyroid cancer within inpatient settings in the United States from 2001-2010. To determine the direct inpatient burden of and describe the characteristics of patients and hospitals associated with metastatic thyroid cancer. Methods: A multivariate retrospective cohort study was performed on the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database, for the years 2001-2010, focusing on three main outcomes: inpatient mortality, inpatient charges, and inpatient length of stay. Regression analyses controlled for patient demographics, hospital characteristics, payer, clinical comorbidities, and site of metastases. Inclusion criteria included: age ≥ 18 years, any listed diagnosis of thyroid cancer, and any listed secondary malignancy. Main Results: Overall, 84,191 inpatient cases were observed for metastatic thyroid cancer with 3,032 resulting in mortality (3.6%). The total charges were $3.1 billion (USD 2012) for overall inpatient hospitalizations with average inpatient charges at $38,292 (SD±56,135) for each overall case and $80,948 (SD±117,645) for each mortality-only case. Higher inpatient mortality, charges, and length of stay were significantly associated with central nervous system and lung metastatic cancer sites (p < 0.01) and deficiency anemias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss comorbidities (p < 0.01). Conclusion: There is a considerable national inpatient burden of metastatic thyroid cancer. The analyses in this study quantify the associations and outcomes, and as such can be used to assist in the prediction of those outcomes and clinical decision-making.

Throughout the existence of the United States there have been multiple ways to seek healthcare insurance, and healthcare services and treatment. As the country developed a system in which healthcare was distributed was created. As such, this system has created societal divisions and has caused certain people to be excluded from gaining access to healthcare insurance and treatment. From these divisions, certain stigmas and stereotypes have been created about the type of person that does not have access to healthcare. With certain historical reforms in the U.S. healthcare system being currently implemented, the healthcare system is to change dramatically. However, certain people are still being excluded from gaining access to healthcare insurance and healthcare services. The following thesis, based on research which was conducted from April to July 2014 in the Brooklyn borough of New York City, explores the manner in which recent developments and changes within the healthcare system of the United States inhibits the city’s residents from obtaining basic health care. By focusing on medical encounters, this thesis focuses on how agencies of power retain control of the body, and those that seek access to healthcare. This thesis also explores the opinion of the uninsured patients by those who volunteer at The Coalition of Concerned Medical Professionals, which is an organization that offers free healthcare services while acting as political advocates.