Journal of the National Cancer Institute · 2026
Mortality after emergency presentation: evidence from a cohort of 929 378 Medicare beneficiaries with common cancers diagnosed 2008-2017.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Thompson Caroline A, He Yuelin, Soppe Sarah E, Zhang Xueer, Mullins Megan A, Barclay Matthew E, Pettit Nicholas, Kurian Allison W, Dillon Ellis C, Pruitt Sandi, Lyratzopoulos Georgios
Аннотация
BACKGROUND: Emergency presentation (EP) for cancer diagnosis is associated with higher mortality, but prior research has largely focused on select cancer types or non-U.S. populations. We estimated EP prevalence and associated mortality across 16 cancers in a national Medicare cohort.
METHODS: Using SEER-Medicare data, we identified patients with 16 high-burden cancers diagnosed 2008-2017. EP was defined by an ED claim within 30 days before the index cancer claim and subtyped as inpatient EP (emergency hospitalization) or outpatient EP (following ED discharge). We estimated survival probabilities and mortality risk ratios (RRs) adjusted for demographics, tumor characteristics, comorbidity, frailty, and healthcare utilization.
RESULTS: Among 929,378 patients, 28% were EPs (22% inpatient, 6% outpatient). EP prevalence ranged from <10% (breast, prostate) to > 40% (liver, lung, stomach, colon, ovarian, pancreatic cancers). One-year survival was 81% for non-EPs, 60% for outpatient EPs, and 36% for inpatient EPs. Compared with non-EPs, inpatient EPs had nearly 4-fold higher 30-day adjusted mortality (RR = 3.88, 95% CI: 3.81-3.96), ranging from 2.1 (pancreas) to 6.3 (lymphoma). Among 90-day survivors, inpatient EPs had 51% higher one-year mortality (RR = 1.51, 1.49-1.52), ranging from 1.1 (pancreas) to 2.1 (lymphoma). Outpatient EPs showed intermediate risk (one-year mortality RR = 1.28, 1.26-1.30).
CONCLUSION: EP is common and predicts persistently elevated mortality in older U.S. adults after comprehensive covariate adjustment. Associations were strongest for cancer types underrepresented in prior research, including hematologic malignancies, breast, prostate, and bladder cancers. Routine EP monitoring could improve risk stratification at diagnosis and guide efforts to reduce avoidable emergency presentations.
METHODS: Using SEER-Medicare data, we identified patients with 16 high-burden cancers diagnosed 2008-2017. EP was defined by an ED claim within 30 days before the index cancer claim and subtyped as inpatient EP (emergency hospitalization) or outpatient EP (following ED discharge). We estimated survival probabilities and mortality risk ratios (RRs) adjusted for demographics, tumor characteristics, comorbidity, frailty, and healthcare utilization.
RESULTS: Among 929,378 patients, 28% were EPs (22% inpatient, 6% outpatient). EP prevalence ranged from <10% (breast, prostate) to > 40% (liver, lung, stomach, colon, ovarian, pancreatic cancers). One-year survival was 81% for non-EPs, 60% for outpatient EPs, and 36% for inpatient EPs. Compared with non-EPs, inpatient EPs had nearly 4-fold higher 30-day adjusted mortality (RR = 3.88, 95% CI: 3.81-3.96), ranging from 2.1 (pancreas) to 6.3 (lymphoma). Among 90-day survivors, inpatient EPs had 51% higher one-year mortality (RR = 1.51, 1.49-1.52), ranging from 1.1 (pancreas) to 2.1 (lymphoma). Outpatient EPs showed intermediate risk (one-year mortality RR = 1.28, 1.26-1.30).
CONCLUSION: EP is common and predicts persistently elevated mortality in older U.S. adults after comprehensive covariate adjustment. Associations were strongest for cancer types underrepresented in prior research, including hematologic malignancies, breast, prostate, and bladder cancers. Routine EP monitoring could improve risk stratification at diagnosis and guide efforts to reduce avoidable emergency presentations.