Race, socioeconomics had impact on emergency colorectal cancer diagnosis
Twenty-nine percent of patients with colorectal cancer in a nationally representative sample were diagnosed after an emergency, such as an obstruction or perforation of the bowel, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held here Oct. 16-19, 2012. In addition, African-Americans and those living in high-poverty areas were more likely to present with an emergency diagnosis.
"Overall, there are high rates of emergency presentation of colorectal cancer in the United States," said Sandi L. Pruitt, Ph.D., M.P.H., assistant professor in the department of clinical sciences at The University of Texas Southwestern Medical Center in Dallas. "Screening for colorectal cancer using tests including colonoscopy is recommended for all healthy, asymptomatic adults starting at age 50. But these high rates of emergencies indicate that there are multiple missed opportunities for screening. As a result, many patients are not diagnosed until they have an emergency, such as an obstruction or perforation of the bowel, which leads to more complications and a higher risk for death from cancer."
Pruitt and colleagues evaluated disparities in emergency colorectal cancer presentation using nationally representative Surveillance Epidemiology and End Results–Medicare data from 1992 to 2005 of U.S. adults aged 66 and older with invasive colorectal cancer.
They identified 88,859 patients with colorectal cancer, and of those, 29 percent presented as emergencies. Of these, 81.3 percent had an emergency admission, 31.6 percent were obstructions and 4.2 percent were perforations. In unadjusted analyses, African-American patients with colorectal cancer were 64 percent more likely to present as emergency cases, and those patients with colorectal cancer living in census tracts with the highest poverty rate (greater than or equal 20 percent versus less than 10 percent poverty) were 31 percent more likely to present as emergencies.
After researchers statistically controlled for multiple factors including cancer stage, patient health status and sociodemographic factors, African-Americans were 29 percent more likely to present with emergency cases, and those living in census tracts with the highest poverty rate were 10 percent more likely to present with emergency colorectal cancer.
"We already know that African-Americans and economically disadvantaged populations face an increased risk for death from colorectal cancer," Pruitt said. "In future research, we will attempt to understand how emergency presentation of colorectal cancer contributes to racial and economic disparities in death from colorectal cancer."
More information: A94 Missed opportunities: Racial and socioeconomic disparities in emergency presentation of colorectal cancer. Sandi L. Pruitt1, Nicholas O. Davidson2, Samir Gupta1, Yan Yan2, Mario Schootman2. 1University of Texas Southwestern Medical Center, Dallas, TX, 2Washington University School of Medicine, St. Louis, MO.
Background: Emergency presentation for colorectal cancer (CRC) is common and associated with high morbidity and mortality. African Americans and those with lower socioeconomic status (SES) experience higher CRC morbidity and mortality, and higher rates of emergency CRC presentation may, in part, account for these disparities. We hypothesized that African Americans and individuals with low SES have higher rates of emergency CRC presentation.
Methods: We examined disparities in emergency CRC presentation using nationally representative 1992-2005 SEER-Medicare data of U.S. adults aged ≥66 years with invasive CRC. Emergency CRC presentation (the primary outcome) was defined as a newly diagnosed CRC associated with: obstruction, perforation, or an inpatient admission requiring immediate medical intervention (e.g. for severe, life threatening conditions) identified using Medicare claims with ICD-9 and admission type codes. We used logistic regression to compare associations of race and census tract poverty rate with emergency CRC presentation, adjusting for sociodemographic (age, sex, Medicaid status, year of diagnosis, urban/rural residence at diagnosis), tumor (SEER historic stage, left/right side tumor location, grade, histology), and clinical (history of the following in the prior year: preventable hospitalizations, comorbidity, endoscopic testing) covariates.
Results: We identified 88,859 patients with CRC during the study period, 29.0% of whom presented emergently (of these, 81.3% had an emergency admission, 31.6% obstruction, and 4.2% perforation). In unadjusted analyses, CRC patients more likely to present emergently included African Americans (vs. whites OR: 1.64 95% CI: 1.57-1.72) and those living in census tracts with the highest poverty rate (≥20% vs. <10% poverty OR: 1.31 95% CI: 1.26-1.37). In a single multivariable model, after adjusting for all covariates including tumor stage, African Americans (vs. whites AOR: 1.29 95% CI: 1.21-1.37) and those living in census tracts with the highest poverty rate (≥20% vs. <10% poverty AOR: 1.10 95% CI: 1.04-1.16) continued to be more likely to present emergently.
Discussion: In this population-based study, racial and socioeconomic disparities are evident in emergency presentation of CRC, which may account for some of the observed disparities in morbidity and mortality. Targeted efforts to increase CRC screening in these populations would reduce this preventable disparity.
Provided by American Association for Cancer Research
- ACP releases new colorectal cancer screening guidance statement Mar 05, 2012 | not rated yet | 0
- Study finds colorectal cancer mortality dropping slower in African Americans Dec 22, 2011 | not rated yet | 0
- Prevalence, predictors of interval colorectal cancer ID'd Jun 08, 2012 | not rated yet | 0
- The Medical Minute: Screening can prevent colorectal cancer Mar 23, 2010 | not rated yet | 0
- Family history and screening for colorectal cancer Jun 09, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
Marie Curie's leukemia
May 13, 2013 Does anyone know what might be the cause of Marie Curie's cancer
- More from Physics Forums - Medical Sciences
More news stories
The use of a smartphone application significantly improves patients' preparation for a colonoscopy, according to new research presented today at Digestive Disease Week (DDW). The preparation process, which begins days in ...
Cancer 21 hours ago | not rated yet | 0
Research presented at Digestive Disease Week (DDW) explores new methods for managing digestive health through diet and lifestyle.
Cancer 21 hours ago | not rated yet | 1
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
Cancer May 18, 2013 | 5 / 5 (2) | 0
(HealthDay)—Concurrent use of two immune checkpoint antibodies—ipilimumab and nivolumab—may be effective for the treatment of advanced melanoma, according to a proof-of-principal study presented in ...
Cancer May 17, 2013 | not rated yet | 0
(HealthDay)—The risks of metastasis and death associated with cutaneous squamous cell carcinoma (CSCC) are low, but significant, and risk factors for poor outcome include tumor diameter, invasion beyond ...
Cancer May 17, 2013 | not rated yet | 0 |
Researchers at the University of Wisconsin have identified a potential new risk factor for obstructive sleep apnea: asthma. Using data from the National Institutes of Health (Heart, Lung, and Blood Institute)-funded Wisconsin ...
9 hours ago | not rated yet | 0 |
In their quest to learn more about the variability of cells between and within tissues, biomedical scientists have devised tools capable of simultaneously measuring dozens of characteristics of individual ...
10 hours ago | 5 / 5 (2) | 0 |
Scientists at Johns Hopkins have turned their view of osteoarthritis (OA) inside out. Literally. Instead of seeing the painful degenerative disease as a problem primarily of the cartilage that cushions joints, ...
10 hours ago | 4.8 / 5 (4) | 0 |
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
9 hours ago | 5 / 5 (2) | 0 |
The hunt for an HIV vaccine has gobbled up $8 billion in the past decade, and the failure of the most recent efficacy trial has delivered yet another setback to 26 years of efforts.
14 hours ago | not rated yet | 0
Gourmands and foodies everywhere have long recognized ginger as a great way to add a little peppery zing to both sweet and savory dishes; now, a study from researchers at Columbia University shows purified components of the ...
9 hours ago | not rated yet | 0