Article Text
Abstract
Background Diagnosis of cancer through emergency presentation is associated with poorer prognosis. While reductions in emergency presentations have been described, whether known sociodemographic inequalities are changing is uncertain.
Methods We analysed ‘Routes to Diagnosis’ data on patients aged ≥25 years diagnosed in England during 2006–2013 with any of 33 common or rarer cancers. Using binary logistic regression we determined time-trends in diagnosis through emergency presentation by age, deprivation and cancer site.
Results Overall adjusted proportions of emergency presentations decreased during the study period (2006: 23%, 2013: 20%). Substantial baseline (2006) inequalities in emergency presentation risk by age and deprivation remained largely unchanged. There was evidence (p<0.05) of reductions in the risk of emergency presentations for most (28/33) cancer sites, without apparent associations between the size of reduction and baseline risk (p=0.26). If there had been modest reductions in age inequalities (ie, patients in each age group acquiring the same percentage of emergency presentations as the adjacent group with lower risk), in the last study year we could have expected around 11 000 fewer diagnoses through emergency presentation (ie, a nationwide percentage of 16% rather than the observed 20%). For similarly modest reductions in deprivation inequalities, we could have expected around 3000 fewer (ie, 19%).
Conclusion The proportion of cancer diagnoses through emergency presentation is decreasing but age and deprivation inequalities prevail, indicating untapped opportunities for further improvements by reducing these inequalities. The observed reductions in proportions across nearly all cancer sites are likely to reflect both earlier help-seeking and improvements in diagnostic healthcare pathways, across both easier-to-suspect and harder-to-suspect cancers.
- cancer
- inequalities
- ageing
- deprivation
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Footnotes
Contributors Planning: GL, AH, SW, SMcP. Conduct: AH, SW, GAA, LE-B. Reporting: AH, GL, SW, LE-B, SMcP, GAA. All authors contributed to the conceptualisation of the paper and its methods and the drafting of the final manuscript.
Funding AH and GL are supported by a Cancer Research UK Advanced Clinician Scientist Fellowship to GL (award C18081/A18180). GL is an associate director (co-investigator) of the multi-institutional CanTest Research Collaborative funded by a Cancer Research UK Population Research Catalyst award (C8640/A23385).
Competing interests None declared.
Patient consent Not required.
Ethics approval We used anonymous (de-personalised) aggregated data for which no ethical approval is required.
Provenance and peer review Not commissioned; externally peer reviewed.