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.

Citation Format: Sandi L. Pruitt, Nicholas O. Davidson, Samir Gupta, Yan Yan, Mario Schootman. Missed opportunities: Racial and socioeconomic disparities in emergency presentation of colorectal cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A94.

©2012 American Association for Cancer Research.
2012