title: Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery.
abstract: BACKGROUND
  Disparities by race and neighborhood socioeconomic status exist for many colorectal cancer (CRC) outcomes, including screening use and mortality. We used population-based data to determine if disparities also exist for emergency CRC diagnosis and surgery.
  
  
  METHODS
  We examined two emergency CRC outcomes using 1992-2005 population-based U.S. SEER-Medicare data. Among CRC patients aged ≥66 years, we examined racial (African American vs. white) and neighborhood poverty disparities in two emergency outcomes defined as: 1) newly diagnosed CRC or 2) CRC surgery associated with: obstruction, perforation, or emergency inpatient admission. Multilevel logistic regression (patients nested in census tracts) analyses adjusted for sociodemographic, tumor, and clinical covariates.
  
  
  RESULTS
  Of 83,330 CRC patients, 29.1% were diagnosed emergently. Of 55,046 undergoing surgery, 26.0% had emergency surgery. For both outcomes, race and neighborhood poverty disparities were evident. A significant race by poverty interaction (p < .001) was noted: poverty rate was associated with both outcomes among African Americans, but not whites. Compared to whites in low poverty (<10%) neighborhoods, African Americans in high poverty (≥20%) neighborhoods had increased odds of emergency diagnosis (AOR: 1.50, 95% CI: 1.38-1.63) and surgery (AOR: 1.63, 95% CI: 1.47-1.81).
  
  
  CONCLUSIONS
  Emergency CRC outcomes are associated with high poverty residence among African Americans in this population-based study, potentially contributing to observed disparities in CRC morbidity and mortality. Targeted efforts to increase CRC screening among African Americans living in high poverty neighborhoods could reduce preventable disparities.
authors.affiliation: Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd E1, 410D Dallas, TX, USA. Sandi.Pruitt@utsouthwestern.edu.
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
authors.forename: Nicholas O
authors.initials: NO
authors.lastname: Davidson
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
mesh_terms: D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000601:surgery*; D055088:Early Detection of Cancer; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*