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Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study.
Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study. JNCI cancer spectrum Thompson, C. A., Sheridan, P., Metwally, E., Peacock Hinton, S., Mullins, M. A., Dillon, E. C., Thompson, M., Pettit, N., Kurian, A. W., Pruitt, S. L., Lyratzopoulos, G. 2024Abstract
Internationally, 20-50% 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 U.S. is limited. We estimated Emergency Department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and associations with sociodemographic, clinical, and tumor characteristics.We analyzed SEER-Medicare data for Medicare beneficiaries (=66?years old) diagnosed with 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 0-30?days before their index date to have "ED involvement" in their diagnosis, with stratification as 0-7 or 8-30?days. We estimated covariate-adjusted associations of patient age, sex, race/ethnicity, marital status, comorbidity score, tumor stage, diagnosis year, rurality, and census tract poverty with ED involvement using modified Poisson regression.Among 614,748 patients, 23% had ED involvement with 18% visiting the ED in the 0-7?days before their index date. This varied greatly by tumor site: breast 8%, colorectal 39%, lung 40%, prostate 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian/Other Pacific Islander race, being unmarried, recent diagnosis year, later-stage disease, comorbidities, and poverty were associated with ED involvement.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.
View details for DOI 10.1093/jncics/pkae039
View details for PubMedID 38796687