Emergency Department Visits Before Cancer Diagnosis Among Women at Mayo Clinic

Sally K. Stauder BS , Shalmali R. Borkar MBBS, MPH , Amy E. Glasgow MHA , Tage L. Runkle MA , Mark E. Sherman MD , Aaron C. Spaulding PhD , Michael M. Mohseni MD , Christopher C. DeStephano MD, MPH
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引用次数: 0

Abstract

Objective

To determine associations of incident cancer diagnoses in women with recent emergency department (ED) care.

Patients and Methods

A retrospective cohort study analyzing biological females aged 18 years and older, who were diagnosed with an incident primary cancer (12 cancer types studied) from January 1, 2015, to December 31, 2021, from electronic health records. The primary outcome was a cancer diagnosis within 6 months of a preceding ED visit. Secondary outcomes included patient factors associated with a preceding ED visit.

Results

Of 25,736 patients (median age of 62 years, range 18-101) diagnosed with an incident primary cancer, 1938 (7.5%) had an ED visit ≤6 months before a diagnosis. The ED-associated cancer cases were highest in lung cancer (n=514, 14.7%) followed by acute lymphoblastic leukemia (n=22, 13.3%). Patient factors increasing the likelihood of ED evaluation before diagnosis included 18-50 years of age (OR=1.32; 95% CI, 1.09-1.61), Elixhauser score (measure of comorbidities) >4 (OR=17.90; 95% CI, 14.21-22.76), use of Medicaid or other government insurance (OR=2.10; 95% CI, 1.63-2.69), residence within the institutional catchment areas (OR=3.18; 95% CI, 2.78-3.66), non-Hispanic Black race/ethnicity (OR=1.41; 95% CI, 1.04-1.88), and established primary care provider at Mayo Clinic (OR=1.45; 95% CI, 1.28-1.65). The ED visits were more likely in those who died within 6 months of diagnosis (n=327, 37.8%) than those who did not die (n=1611, 6.5%).

Conclusion

Patient characteristics identified in this study offer opportunities to provide cancer risk assessment and health navigation, particularly among individuals with comorbidities and limited health care access.

梅奥诊所妇女癌症诊断前的急诊就诊情况
患者和方法该回顾性队列研究分析了从 2015 年 1 月 1 日至 2021 年 12 月 31 日期间电子健康记录中被诊断为原发性癌症(研究的 12 种癌症类型)的 18 岁及以上女性患者。主要结果是在前一次急诊就诊后 6 个月内确诊癌症。结果 在确诊为原发性癌症的 25736 名患者(中位年龄为 62 岁,年龄范围为 18-101 岁)中,有 1938 人(7.5%)在确诊前 6 个月曾在急诊室就诊。与急诊室相关的癌症病例以肺癌最多(514 例,14.7%),其次是急性淋巴细胞白血病(22 例,13.3%)。增加诊断前进行 ED 评估可能性的患者因素包括:18-50 岁(OR=1.32;95% CI,1.09-1.61)、Elixhauser 评分(衡量合并症)>4(OR=17.90;95% CI,14.21-22.76)、使用医疗补助或其他政府保险(OR=2.10;95% CI,1.63-2.69)、居住在机构覆盖区内(OR=3.18;95% CI,2.78-3.66)、非西班牙裔黑人种族/民族(OR=1.41;95% CI,1.04-1.88)、在梅奥诊所有固定的初级保健提供者(OR=1.45;95% CI,1.28-1.65)。与未死亡的患者(1611 人,6.5%)相比,诊断后 6 个月内死亡的患者(327 人,37.8%)更有可能去急诊室就诊。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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