Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers.
BACKGROUND
Although overall sociodemographic and cancer site variation in the risk of cancer diagnosis through emergency presentation has been previously described, relatively little is known about how this risk may vary differentially by sex, age and deprivation group between patients with a given cancer.


METHODS
Data from the Routes to Diagnosis project on 749,645 patients (2006-2010) with any of 27 cancers that can occur in either sex were analysed. Crude proportions and crude and adjusted odds ratios were calculated for emergency presentation, and interactions between sex, age and deprivation with cancer were examined.


RESULTS
The overall proportion of patients diagnosed through emergency presentation varied greatly by cancer. Compared with men, women were at greater risk for emergency presentation for bladder, brain, rectal, liver, stomach, colon and lung cancer (e.g., bladder cancer-specific odds ratio for women vs men, 1.50; 95% CI 1.39-1.60), whereas the opposite was true for oral/oropharyngeal cancer, lymphomas and melanoma (e.g., oropharyngeal cancer-specific odds ratio for women vs men, 0.49; 95% CI 0.32-0.73). Similarly, younger patients were at higher risk for emergency presentation for acute leukaemia, colon, stomach and oesophageal cancer (e.g., colon cancer-specific odds ratio in 35-44- vs 65-74-year-olds, 2.01; 95% CI 1.76-2.30) and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin's lymphoma (e.g., melanoma specific odds ratio in 35-44- vs 65-74-year-olds, 0.20; 95% CI 0.12-0.33). Inequalities in the risk of emergency presentation by deprivation group were greatest for oral/oropharyngeal, anal, laryngeal and small intestine cancers.


CONCLUSIONS
Among patients with the same cancer, the risk for emergency presentation varies notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated both with psychosocial processes, which can delay seeking of medical help, and with difficulties in suspecting the diagnosis of cancer after presentation.
Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
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Abel
1] Care Quality Commission, Finsbury Tower, 103-105 Bunhill Row, London EC1Y 8TG, UK [2] National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
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Shelton
National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
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Johnson
National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK.
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Elliss-Brookes
1] Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK [2] National Cancer Intelligence Network (NCIN), Public Health England, 5th Floor, Wellington House, 135-155 Waterloo Road, London SE1 8UG, UK [3] Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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Lyratzopoulos
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D035583:Rare Diseases / Q000175:diagnosis*; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors