(ChemotherapyAdvisor) – In a nationally representative sample of patients with colorectal cancer (CRC), 29% were diagnosed after an emergency, such as an obstruction or perforation of the bowel, and those more likely to present with an emergency diagnosis were African American or of lower socioeconomic status, investigators noted during the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research.
This finding “may account for some of the observed disparities in morbidity and mortality,” said Sandi L. Pruitt, PhD, MPH, of The University of Texas Southwestern Medical Center, Dallas, TX, and colleagues. “Targeted efforts to increase CRC screening in these populations would reduce this preventable disparity.”
Using nationally representative 1992-2005 Surveillance Epidemiology and End Results (SEER)-Medicare data of U.S. adults aged ≥66 years with invasive CRC, the investigators examined disparities in emergency CRC presentation, the primary study outcome. Medicare claims with ICD-9 and admission type codes were used to identify emergency CRC presentation, defined as a newly diagnosed CRC associated with obstruction or perforation, or an inpatient admission requiring immediate medical intervention; eg, for severe, life threatening conditions.
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“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,” she reported.
Of the 88,859 patients with CRC, 29% presented emergently; of these, 81.3% had an emergency admission; 31.6%, an obstruction; and 4.2%, a perforation. In unadjusted analyses, African American patients with colorectal cancer were 64% more likely to present as emergency cases (95% CI 1.57–1.72), and those living in census tracts with the highest poverty rate (≥20% vs <10%) were 31% more likely to present as emergencies (95% CI: 1.26–1.37), Dr. Pruitt noted.
In a single multivariable model, after adjusting for all covariates, including tumor stage, African Americans were 29% more likely (95% CI: 1.21–1.37) and those living in census tracts with the highest poverty rate, 10% more likely (95% CI: 1.04–1.16) to present emergently.
“We already know that African Americans and economically disadvantaged populations face an increased risk for death from colorectal cancer,” Dr. 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.”
Funding sources included the Cancer Prevention Research Institute of Texas, the National Cancer Institute, and the National Center for Research Resources.
