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医疗服务可及性差异对急诊科乳腺癌初诊的影响

Impact of Healthcare Access Disparities on Initial Diagnosis of Breast Cancer in the Emergency Department.

作者信息

Yee Allison M, Mazumder Preeanka K, Dong Fanglong, Neeki Michael M

机构信息

Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.

Emergency Medicine, California University of Science and Medicine, San Bernardino, USA.

出版信息

Cureus. 2020 Aug 25;12(8):e10027. doi: 10.7759/cureus.10027.

Abstract

Breast cancer continues to be the second leading cause of cancer deaths in women in the United States. This is more noticeable in communities with pronounced healthcare disparities. The aim of this study was to investigate the different demographics that might play a role in the detection of breast cancer in a county hospital emergency department (ED). A retrospective study was conducted of female patients diagnosed with breast cancer over a five-year period (1/1/2015 to 12/31/2018). Patients with breast cancer as the primary or secondary diagnosis were identified. This study shows that 66 (73.3%) women diagnosed in the ED were Hispanic or African American. There was a significant delay (a median of 461 days) in the time between the diagnosis of suspected breast cancer in the ED to their follow-up visit with definitive diagnosis in a primary care clinic. These findings suggest that women with a suspected breast cancer diagnosis who are seen in a safety net hospital and have Medicaid funding may have significant delays before final diagnosis is made. Patient demographics could have an impact on the patients' access to screening and regular healthcare visits, hindering an early breast cancer diagnosis by a primary care provider.

摘要

乳腺癌仍然是美国女性癌症死亡的第二大主要原因。这在医疗保健差距显著的社区中更为明显。本研究的目的是调查在县医院急诊科(ED)中,可能在乳腺癌检测中起作用的不同人口统计学特征。对在五年期间(2015年1月1日至2018年12月31日)被诊断患有乳腺癌的女性患者进行了一项回顾性研究。确定了以乳腺癌作为主要或次要诊断的患者。这项研究表明,在急诊科被诊断出的66名(73.3%)女性为西班牙裔或非裔美国人。从在急诊科疑似乳腺癌诊断到在初级保健诊所进行最终诊断的随访之间,存在显著延迟(中位数为461天)。这些发现表明,在安全网医院就诊且有医疗补助资金的疑似乳腺癌诊断女性,在最终诊断之前可能会有显著延迟。患者的人口统计学特征可能会影响患者获得筛查和定期医疗就诊的机会,从而阻碍初级保健提供者对乳腺癌的早期诊断。

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