Background

More deprived cancer patients are at higher risk of Emergency Presentation (EP) with most studies pointing to lower symptom awareness and increased comorbidities to explain those patterns. With the example of colon cancer, we examine patterns of hospital emergency admissions (HEAs) history in the most and least deprived patients as a potential precursor of EP.

Methods

We analysed the rates of hospital admissions and their admission codes (retrieved from Hospital Episode Statistics) in the two years preceding cancer diagnosis by sex, deprivation and route to diagnosis (EP, non-EP). To select the conditions (grouped admission codes) that best predict emergency admission, we adapted the purposeful variable selection to mixed-effects logistic regression.

Results

Colon cancer patients diagnosed through EP had the highest number of HEAs than all the other routes to diagnosis, especially in the last 7 months before diagnosis. Most deprived patients had an overall higher rate and higher probability of HEA but fewer conditions associated with it.

Conclusions

Our findings point to higher use of emergency services for non-specific symptoms and conditions in the most deprived patients, preceding colon cancer diagnosis. Health system barriers may be a shared factor of socio-economic inequalities in EP and HEAs.

中文翻译：

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癌症诊断前的医院紧急入院可以告诉我们关于癌症诊断中的社会经济不平等的什么信息？来自英格兰人口数据的证据

背景

贫困程度较高的癌症患者出现紧急就诊 (EP) 的风险较高，大多数研究指出，这些模式是由于症状意识较低和合并症增加所致。以结肠癌为例，我们检查了最贫困和最贫困患者的医院急诊入院 (HEA) 病史模式，将其作为 EP 的潜在先兆。

方法

我们按性别、剥夺和诊断途径（EP、非 EP）分析了癌症诊断前两年的入院率及其入院代码（从医院事件统计中检索）。为了选择最能预测紧急入院的条件（分组入院代码），我们将有目的的变量选择调整为混合效应逻辑回归。

结果

通过 EP 诊断的结肠癌患者的 HEA 数量高于所有其他诊断途径，尤其是在诊断前的最后 7 个月。大多数贫困患者的 HEA 总体发病率和概率较高，但与之相关的病症较少。

结论

我们的研究结果表明，在结肠癌诊断之前，最贫困的患者会更多地使用紧急服务来应对非特异性症状和状况。卫生系统障碍可能是 EP 和 HEA 社会经济不平等的共同因素。