Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Study.
Disparities in Presentation at Time of Hepatocellular Carcinoma Diagnosis: A United States Safety-Net Collaborative Study.
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DOI：
10.1245/s10434-020-09156-4
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发表时间：
2021-04
影响因子：
3.7
通讯作者：
Goel N
中科院分区：
文献类型：
--
作者：
Kronenfeld JP;Ryon EL;Goldberg D;Lee RM;Yopp A;Wang A;Lee AY;Luu S;Hsu C;Silberfein E;Russell MC;Livingstone AS;Merchant NB;Goel N
虽然肝细胞癌（HCC）通过筛查高危患者理想地在门诊诊断，但由于未诊断的肝病和/或有限的医疗保健，许多人在急诊科（艾德）诊断。本研究旨在确定与在艾德被诊断为HCC相关的社会人口统计学/临床因素，以确定可能从改善获得护理中受益的患者。从美国安全网协作数据库中识别出2012年至2014年在艾德或门诊环境[初级保健医生（PCP）或肝病学家]中诊断的HCC患者，并进行了回顾性图表审查。多变量回归分析确定了艾德诊断的预测因子。在1620例患者中，中位年龄为60岁，68%在门诊诊断，32%在ED诊断。艾德患者更可能是男性，黑人/西班牙裔，无保险，并表现出更多的失代偿性肝病，侵袭性特征和晚期临床分期。在多变量回归分析中，控制了年龄、性别、种族/民族、贫困、保险和PCP/导航器访问，艾德诊断的预测因素为男性（比值比[OR] 1.6，95%置信区间[CI]：1.1-2.2，p = 0.010），黑人（OR 1.7，95% CI：1.2-2.3，p = 0.002），西班牙裔（OR 1.6，95% CI：1.1-2.6，p = 0.029），低于贫困线25%（OR 1.4，95% CI：1.1-1.9，p = 0.019），无保险（OR 3.9，95% CI：2.4-6.1，p < 0.001），以及缺乏PCP（OR 2.3，95% CI：1.5-3.6，p < 0.001）或导航仪（OR 1.8，95% CI：1.3-2.5，p = 0.001）。ED中诊断为HCC的患者的社会人口统计学/临床特征与门诊诊断的患者显著不同。艾德患者更可能是少数种族/民族，没有保险，获得医疗保健的机会有限。这项研究强调了改善本已脆弱的人群获得护理的重要性。
While hepatocellular carcinoma (HCC) is ideally diagnosed outpatient by screening at-risk patients, many are diagnosed in Emergency Departments (ED) due to undiagnosed liver disease and/or limited access-to-healthcare. This study aims to identify sociodemographic/clinical factors associated with being diagnosed with HCC in the ED to identify patients who may benefit from improved access-to-care. HCC patients diagnosed between 2012 and 2014 in the ED or an outpatient setting [Primary Care Physician (PCP) or hepatologist] were identified from the US Safety-Net Collaborative database and underwent retrospective chart-review. Multivariable regression identified predictors for an ED diagnosis. Among 1620 patients, median age was 60, 68% were diagnosed outpatient, and 32% were diagnosed in the ED. ED patients were more likely male, Black/Hispanic, uninsured, and presented with more decompensated liver disease, aggressive features, and advanced clinical stage. On multivariable regression, controlling for age, gender, race/ethnicity, poverty, insurance, and PCP/navigator access, predictors for ED diagnosis were male (odds ratio [OR] 1.6, 95% confidence interval [CI]: 1.1–2.2, p = 0.010), black (OR 1.7, 95% CI: 1.2–2.3, p = 0.002), Hispanic (OR 1.6, 95% CI: 1.1–2.6, p = 0.029), > 25% below poverty line (OR 1.4, 95% CI: 1.1–1.9, p = 0.019), uninsured (OR 3.9, 95% CI: 2.4–6.1, p < 0.001), and lack of PCP (OR 2.3, 95% CI: 1.5–3.6, p < 0.001) or navigator (OR 1.8, 95% CI: 1.3–2.5, p = 0.001). The sociodemographic/clinical profile of patients diagnosed with HCC in EDs differs significantly from those diagnosed outpatient. ED patients were more likely racial/ethnic minorities, uninsured, and had limited access to healthcare. This study highlights the importance of improved access-to-care in already vulnerable populations.
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影响因子：
--
作者：
Ghouri YA;Mian I;Rowe JH
通讯作者：
Rowe JH
影响因子：
2.5
作者：
Goldberg, D. S.;Valderrama, A.;Lewis, J. D.
通讯作者：
Lewis, J. D.
DOI：
10.6004/jnccn.2015.0074
发表时间：
2015-05
期刊：
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子：
--
作者：
Patel N;Yopp AC;Singal AG
通讯作者：
Singal AG
影响因子：
12.6
作者：
Simmons, Okeefe L.;Feng, Yuan;Singal, Amit G.
通讯作者：
Singal, Amit G.
影响因子：
5.5
作者：
Franco, Ricardo A.;Fan, Yunhua;Galbraith, James
通讯作者：
Galbraith, James