An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care

William C. Livingood, Carmen Smotherman, Katryne Lukens-Bull, Petra Aldridge, Dale F. Kraemer, David L. Wood, Carmine Volpe

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)95-101
Number of pages7
JournalPopulation health management
Issue number2
StatePublished - Apr 1 2016

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Public Health, Environmental and Occupational Health


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