Livingood William C, Smotherman Carmen, Lukens-Bull Katryne, Aldridge Petra, Kraemer Dale F, Wood David L, Volpe Carmine
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.
Popul Health Manag. 2016 Apr;19(2):95-101. doi: 10.1089/pop.2015.0118. Epub 2016 Jan 13.
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).
经济弱势群体依靠急诊科（ED）进行癌症初诊，而非通过初级保健进行早期诊断和治疗，这显然是癌症差异的一个合理原因。将一家安全网医院2009 - 2010年的索赔数据与医院肿瘤登记数据合并，以比较因急诊科相关的癌症初诊住院情况与非急诊科相关的初诊情况。对于所有安全网医院的患者，通过急诊科进行癌症初诊的比例相对较高（32%），但非裔美国人和贫困城市核心区居民的这一比例更高。因使用急诊科进行初诊，与癌症诊断为4期而非1期的风险高75%相关，且在2年研究期内死亡风险高176%。这项关于安全网医院急诊科使用情况的研究结果表明，癌症护理和结局存在巨大差异，对监测差异、《平价医疗法案》的影响以及安全网医院的利用具有重要意义。（《人口健康管理》2016年；19:95 - 101）
