Colorectal cancer: An emergency room diagnosis in African American patients.

A93

BACKGROUND: Colon and rectal cancers are the second leading causes of cancer related deaths in the United States. Survival following a diagnosis of colon or rectal cancer is highly dependent on the stage of initial diagnosis. Current screening guidelines recommend colonoscopy beginning at age 50 years. Numerous factors contribute to disparities in incidence and mortality in colorectal cancer (CRC) patients of different races and ethnicities. Regardless of well published guidelines for CRC screening, a significant number of African American (AA) patients have their initial diagnosis and subsequent care coordinated through the hospital emergency rooms (ER). This suggests that there are disparate differences among the different races and ethnic groups in how they presently access the healthcare system with regard to their initial diagnosis of CRC. METHODS: A retrospective database review was performed utilizing the State of Tennessee Hospital Discharge Data System (HDDS) for the years 1998-2002. This information was extracted with International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes for patient diagnoses and for procedures performed, detailed charges with associated revenue codes, information on the payer or insurer, physician ID number, and demographic data on the patient. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS). Zip codes were utilized as a surrogate for economic status. RESULTS: Our data demonstrated that a statistically significant proportion of AA received their initial diagnosis of CRC through ER visits compared to their white non-Hispanic counterparts (42.6% vs. 23.4%, p-value <0.05). The same is true when elective admissions vs. urgent and emergent admissions were compared. A disproportionate number of AA within their race when compared to non-Hispanic whites are initially diagnosed with CRC through ER visits (41.7% vs. 23.0%, p-value < 0 .05). The same trends exist for the diagnosis of rectal cancer in our database. CONCLUSION: AA disproportionately receive an initial diagnosis of colon and rectal cancer through the ER services as opposed to primary care screening and diagnosis. Further work is needed to promote pro-active health practices and screening for colon and rectal cancer in AA communities.