An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care

Livingood, William C.; Smotherman, Carmen; Lukens-Bull, Katryne; Aldridge, Petra; Kraemer, Dale F.; Wood, David L.; Volpe, Carmine

doi:10.1089/pop.2015.0118

Cited by 21 publications

(24 citation statements)

References 29 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…At the same time, there are major disparities that extend to almost all aspects of care for African Americans. African Americans have a lower likelihood of receiving diagnostic tests for chest pain [17], outpatient visits and care for psychiatric and behavioral needs [18], adequate pain management [19], and treatment of complex CMCs such as DM [20] and cancer [21]. To address the health needs of older adults, there is a need to study both hospitalization and ED visits of this population.…”

Section: Introductionmentioning

confidence: 99%

Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes

Assari

Smith

Bazargan

2020

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

Objectives We investigated the associations between poor self-rated health (SRH), hospitalization, and emergency department (ED) visits among African American older adults with diabetes mellitus (DM). Methods This survey recruited 235 non-institutionalized African American older adults (age > = 55 years) with diabetes mellitus (DM). Participants were recruited using a convenience sample from economically disadvantaged urban areas of South Los Angeles, California. Poor SRH was the independent variable. Hospitalization and ED visits in the past 12 months were the outcomes. Demographic factors, health [comorbid medical conditions (CMCs) and polypharmacy], health behaviors (smoking and drinking), and access (difficulty accessing care, dissatisfaction with the medical care, routine source of care, and visiting the same doctor) were confounders. Binary logistic regressions were used for data analysis. Results Poor SRH was associated with higher odds of hospitalization and ED visit, while all covariates were controlled. Conclusions Poor SRH may be predictive of increased healthcare utilization among African American older adults with DM. Research should test whether close monitoring of African American older adults with DM and poor SRH helps reduce their frequency of hospitalization and ED visits or not.

show abstract

Section: Introductionmentioning

confidence: 99%

Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes

Assari

Smith

Bazargan

2020

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

show abstract

“…Insurance coverage as a relevant SEDH was approached in diverse ways amongst the 16 articles that used it including comparing outcomes between uninsured and insured individuals, (24,30) between publicly and privately insured individuals, (33,(38)(39)(40)46,49) or between uninsured, publicly and privately insured individuals. (23,25,35,(41)(42)(43)47,48) Present in more than half (55%) of the studies analysed, it is the most widely used SEDH in analyses of health care equity identi ed in this review. (It re ects the ability to pay in Levesque's framework).…”

Section: A Insurance Statusmentioning

confidence: 99%

Measuring health equity in emergency care using routinely collected data: a systematic review

Morisod¹,

Luta²,

Marti³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background : Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. The performance assessment of health care systems is often limited to quality and efficiency indicators. Identifying indicators of health care equity is an important first step in integrating the concept of equity into assessments of health care system performance. Because emergency care serves as the interface between ambulatory and inpatient care, it is arguably an opportune setting in which to begin this process. Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analysed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy and financial and non-financial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care. Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Though studies analysed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed. .

show abstract

“…Nationally representative studies on cervical cancer presentation in the emergency department are lacking. Prior work has focused on ED care for patients with gynecologic cancers after their diagnosis or ED diagnostic workup among all cancer patients [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic presentation of cervical cancer in emergency departments in California

Maguire

Cooley

Morris

et al. 2021

Cancer Causes Control

View full text Add to dashboard Cite

Purpose Through screening and HPV vaccination, cervical cancer can mostly be prevented or detected very early, before symptoms develop. However, cervical cancer persists, and many women are diagnosed at advanced stages. Little is known about the degree to which U.S. women may begin their diagnostic workup for cervical cancer in Emergency Departments (ED). We sought to quantify the proportion of women presenting symptomatically in the ED prior to their diagnosis with cervical cancer and to describe their characteristics and outcomes. Methods We identified women diagnosed from 2006 to 2017 with cervical cancer in the California Cancer Registry. We linked this cohort to statewide ED discharge records to determine ED use and symptoms present at the encounter. Multivariable logistic regression models examined associations with ED use and multivariable Cox proportional hazards regression models examined associations with survival. Results Of the more than 16,000 women with cervical cancer in the study cohort, 28% presented symptomatically in the ED prior to diagnosis. Those presenting symptomatically were more likely to have public (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.06–1.27) or no insurance (OR 4.81; CI 4.06–5.71) (vs. private), low socioeconomic status (SES) (OR 1.76; CI 1.52–2.04), late-stage disease (OR 5.29; CI 4.70–5.96), and had a 37% increased risk of death (CI 1.28–1.46). Conclusion Nearly a third of women with cervical cancer presented symptomatically, outside of a primary care setting, suggesting that many women, especially those with low SES, may not be benefiting from screening or healthcare following abnormal results.

show abstract

An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care

Cited by 21 publications

References 29 publications

Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes

Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes

Measuring health equity in emergency care using routinely collected data: a systematic review

Symptomatic presentation of cervical cancer in emergency departments in California

Contact Info

Product

Resources

About