Department of Emergency Medicine, China Medical University & Hospital, Taichung, Taiwan R.O.C.
Department of Public Health, China Medical University, Taichung, Taiwan R.O.C.
BMC Public Health. 2023 Feb 8;23(1):283. doi: 10.1186/s12889-023-15218-5.
Liver cancer is ranked fifth in incidence and second in mortality among cancers in Taiwan. Nevertheless, the Taiwan government does not screen for liver cancer in its free cancer screening and preventive health examination service. This study compared the differences in cancer stage and survival between patients who received an initial liver cancer diagnosis in outpatient departments (OPDs) and those who received such a diagnosis in emergency departments (EDs).
This retrospective cohort study used the 2000-2016 National Health Insurance Database to obtain a sample from 2 million Taiwanese residents. To evaluate the effect of the utilization of the adult health examination offered to people aged ≥ 40 years, patients aged ≥ 40 years who received an initial liver cancer diagnosis between 2003 and 2015 were followed up until December 31, 2016.
In total, 2,881 patients were included in this study. A greater proportion of cancer cases in the OPD group were non-advanced than those in the ED group (75.26% vs. 54.23%). Having stage C or D cancer, having a low monthly salary, and a Charlson comorbidity index score ≥ 8, not having hepatitis B, being divorced, and attending a non-public hospital as the primary care institution were risk factors for initial ED diagnosis. The risk of liver cancer-specific death among the ED group patients was 1.38 times that among the OPD group patients (adjusted hazard ratio = 1.38, 95% confidence interval [CI] = 1.14-1.68, P < 0.001). However, the use of health examination did not exert a significant effect on the likelihood of liver cancer diagnosis in an ED (adjusted odds ratio = 0.86, 95% CI = 0.61-1.21, P = 0.381).
Government-subsidized health examinations are insufficient to prevent first-ever diagnosed liver cancers in EDs. Patients with liver cancers diagnosed in EDs had a higher risk of advanced stage and mortality. For early detection and treatment, the government may consider implementing liver cancer screening for high-risk and low-socioeconomic people.
肝癌在台湾的癌症发病率中排名第五，死亡率排名第二。然而，台湾政府并未将肝癌纳入其免费癌症筛查和预防健康检查服务中。本研究比较了在门诊（OPD）和急诊（ED）首次诊断为肝癌的患者之间癌症分期和生存的差异。
本回顾性队列研究使用 2000-2016 年国家健康保险数据库从 200 万台湾居民中抽取样本。为了评估成人健康检查对≥40 岁人群的利用效果，将 2003 年至 2015 年期间≥40 岁的首次诊断为肝癌的患者进行随访，随访至 2016 年 12 月 31 日。
本研究共纳入 2881 例患者。OPD 组中癌症病例的非晚期比例大于 ED 组（75.26% vs. 54.23%）。患有 C 期或 D 期癌症、月收入较低、Charlson 合并症指数评分≥8、无乙型肝炎、离异和选择非公立医院作为基层医疗机构是首次 ED 诊断的危险因素。ED 组患者的肝癌特异性死亡风险是 OPD 组患者的 1.38 倍（调整后的危险比=1.38，95%置信区间[CI]：1.14-1.68，P<0.001）。然而，健康检查的使用并未对 ED 中肝癌诊断的可能性产生显著影响（调整后的优势比=0.86，95%CI：0.61-1.21，P=0.381）。
政府补贴的健康检查不足以预防 ED 中首次诊断的肝癌。在 ED 中诊断为肝癌的患者有更高的晚期和死亡率风险。为了早期发现和治疗，政府可能考虑为高风险和低社会经济人群实施肝癌筛查。
