title: An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care.
abstract: Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009-2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non-ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization. (Population Health Management 2016;19:95-101).
authors.affiliation: 1 University of Florida College of Medicine-Jacksonville, Center for Health Equity and Quality Research , Jacksonville, Florida.
authors.forename: William C
authors.initials: WC
authors.lastname: Livingood
authors.affiliation: 1 University of Florida College of Medicine-Jacksonville, Center for Health Equity and Quality Research , Jacksonville, Florida.
authors.forename: Carmen
authors.initials: C
authors.lastname: Smotherman
authors.affiliation: 1 University of Florida College of Medicine-Jacksonville, Center for Health Equity and Quality Research , Jacksonville, Florida.
authors.forename: Katryne
authors.initials: K
authors.lastname: Lukens-Bull
authors.affiliation: 1 University of Florida College of Medicine-Jacksonville, Center for Health Equity and Quality Research , Jacksonville, Florida.
authors.forename: Petra
authors.initials: P
authors.lastname: Aldridge
authors.affiliation: 1 University of Florida College of Medicine-Jacksonville, Center for Health Equity and Quality Research , Jacksonville, Florida.|2 University of Florida College of Medicine-Jacksonville , Department of Neurology, Jacksonville, Florida.
authors.forename: Dale F
authors.initials: DF
authors.lastname: Kraemer
authors.affiliation: 3 Department of Pediatrics, ETSU College of Medicine , Johnson City, Tennessee.
authors.forename: David L
authors.initials: DL
authors.lastname: Wood
authors.affiliation: 4 University of Florida College of Medicine-Jacksonville , Department of Surgery, Jacksonville, Florida.
authors.forename: Carmine
authors.initials: C
authors.lastname: Volpe
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D054625:Healthcare Disparities; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy; D058991:Patient Protection and Affordable Care Act; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies