title: Emergency presentation and socioeconomic status in colon cancer.
abstract: BACKGROUND
  Emergency presentation affects up to every fourth patient with colon cancer, and is associated with worse outcomes. The aim of this study was to investigate any association between socioeconomic status (SES) and mode of presentation in colon cancer.
  
  
  METHODS
  Individually attained data on civil status, education and income were linked to quality registries for colon cancer in two large Swedish regions 1997-2006 (n = 12 293) and analyzed by logistic regression, adjusting for age, sex, stage, region and socioeconomic variables.
  
  
  RESULTS
  The frequency of emergency presentation was 23%; 27.8% among patients above the age of 80, and 20.0% among patients aged 70-79 (p < 0.001). There was no difference between men and women (22.6% vs. 23.8%; p = 0.1). Among patients with stage IV colon cancer, 34.6% presented as emergencies. Odds ratio for an emergency presentation in unmarried patients was 1.24 (96% CI 1.04-1.48), and for unmarried patients above the age of 80, OR was 1.45 (95% CI 0.98-2.13). Among patients below the age of 70 with compulsory education only, OR was 1.22 (95% CI 0.98-1.48). For patients within the lowest income quartile (Q1), OR was 1.24 (95% CI 1.04-1.49). This was most pronounced in men (OR 1.34; 95% CI 1.40-1.72), in patients below the age of 70 (OR 1.36; 95% CI 1.02-1.82), and above the age of 80 (OR 1.41; 95% CI 1.00-1.98).
  
  
  CONCLUSIONS
  Emergency presentation of colon cancer is consistently associated with socioeconomic factors, and this must be considered in efforts aimed at reducing the overall frequency of emergency cases.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden. Hanna.gunnarsson@ki.se
authors.forename: H
authors.initials: H
authors.lastname: Gunnarsson
authors.forename: A
authors.initials: A
authors.lastname: Ekholm
authors.forename: L I
authors.initials: LI
authors.lastname: Olsson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016001:Confidence Intervals; D057210:Delayed Diagnosis / Q000191:economics* / Q000706:statistics & numerical data; D004522:Educational Status; D004638:Emergency Treatment / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016017:Odds Ratio; D011203:Poverty; D011379:Prognosis; D012042:Registries; D012044:Regression Analysis; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013548:Sweden
keywords: Civil status; Colon cancer; Education; Emergency; Income