TY - JOUR
T1 - An Elephant in the Emergency Department
T2 - Symptom of Disparities in Cancer Care
AU - Livingood, William C.
AU - Smotherman, Carmen
AU - Lukens-Bull, Katryne
AU - Aldridge, Petra
AU - Kraemer, Dale F.
AU - Wood, David L.
AU - Volpe, Carmine
N1 - Publisher Copyright:
© Copyright 2016, Mary Ann Liebert, Inc.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009-2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non-ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization.
AB - Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009-2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non-ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization.
UR - http://www.scopus.com/inward/record.url?scp=84966522045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84966522045&partnerID=8YFLogxK
U2 - 10.1089/pop.2015.0118
DO - 10.1089/pop.2015.0118
M3 - Article
C2 - 26760720
AN - SCOPUS:84966522045
SN - 1942-7891
VL - 19
SP - 95
EP - 101
JO - Population health management
JF - Population health management
IS - 2
ER -