ECHO (Epidemiology of Cancer Healthcare and Outcomes) Research Group, Department of Behavioural Sciences and Health, Institute of Epidemiology and Health Care, University College London, London, UK.
University of Exeter Medical School (Primary Care), Exeter, UK.
J Epidemiol Community Health. 2019 Jan;73(1):3-10. doi: 10.1136/jech-2017-210371. Epub 2018 Nov 8.
Diagnosis of cancer through emergency presentation is associated with poorer prognosis. While reductions in emergency presentations have been described, whether known sociodemographic inequalities are changing is uncertain.
We analysed 'Routes to Diagnosis' data on patients aged ≥25 years diagnosed in England during 2006-2013 with any of 33 common or rarer cancers. Using binary logistic regression we determined time-trends in diagnosis through emergency presentation by age, deprivation and cancer site.
Overall adjusted proportions of emergency presentations decreased during the study period (2006: 23%, 2013: 20%). Substantial baseline (2006) inequalities in emergency presentation risk by age and deprivation remained largely unchanged. There was evidence (p<0.05) of reductions in the risk of emergency presentations for most (28/33) cancer sites, without apparent associations between the size of reduction and baseline risk (p=0.26). If there had been modest reductions in age inequalities (ie, patients in each age group acquiring the same percentage of emergency presentations as the adjacent group with lower risk), in the last study year we could have expected around 11 000 fewer diagnoses through emergency presentation (ie, a nationwide percentage of 16% rather than the observed 20%). For similarly modest reductions in deprivation inequalities, we could have expected around 3000 fewer (ie, 19%).
The proportion of cancer diagnoses through emergency presentation is decreasing but age and deprivation inequalities prevail, indicating untapped opportunities for further improvements by reducing these inequalities. The observed reductions in proportions across nearly all cancer sites are likely to reflect both earlier help-seeking and improvements in diagnostic healthcare pathways, across both easier-to-suspect and harder-to-suspect cancers.
通过急诊就诊诊断出的癌症与预后较差相关。虽然已经描述了急诊就诊人数的减少，但目前尚不确定已知的社会人口不平等是否在发生变化。
我们分析了 2006 年至 2013 年间在英格兰诊断出的≥25 岁的 33 种常见或罕见癌症患者的“诊断途径”数据。使用二元逻辑回归，我们确定了按年龄、贫困程度和癌症部位划分的通过急诊就诊进行诊断的时间趋势。
研究期间，总体上急诊就诊的调整后比例有所下降（2006 年：23%，2013 年：20%）。年龄和贫困程度方面，急诊就诊风险的基线（2006 年）不平等仍然很大。有证据表明（p<0.05），大多数（33 种癌症中的 28 种）癌症部位的急诊就诊风险有所降低，但减少的幅度与基线风险之间没有明显关联（p=0.26）。如果年龄不平等程度略有降低（即每个年龄组的患者获得与风险较低的相邻组相同比例的急诊就诊），在最后一年的研究中，我们可以预计通过急诊就诊的诊断会减少约 11000 例（即全国范围内的比例为 16%，而不是观察到的 20%）。如果贫困不平等程度略有降低，我们可以预计会减少约 3000 例（即 19%）。
通过急诊就诊诊断出的癌症比例正在下降，但年龄和贫困程度的不平等仍然存在，这表明通过减少这些不平等，可以进一步提高医疗水平。几乎所有癌症部位的比例都有所下降，这可能反映了更容易怀疑和更难怀疑的癌症的早期寻求帮助和诊断医疗途径的改善。
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