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Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study.
- Source :
- JNCI Cancer Spectrum; Jun2024, Vol. 8 Issue 3, p1-10, 10p
- Publication Year :
- 2024
-
Abstract
- Background Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. Methods We analyzed Surveillance, Epidemiology, and End Results Program–Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have "ED involvement" in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. Results Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. Conclusions The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations. [ABSTRACT FROM AUTHOR]
- Subjects :
- CANCER diagnosis
OLDER patients
Subjects
Details
- Language :
- English
- ISSN :
- 25155091
- Volume :
- 8
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- JNCI Cancer Spectrum
- Publication Type :
- Academic Journal
- Accession number :
- 178136495
- Full Text :
- https://doi.org/10.1093/jncics/pkae039