Healthcare disparities among cancer patients in the emergency department: How do race and ethnicity affect bounce-back rates?

Abstract

e18150 Background: Previous studies have demonstrated that patients with cancer utilize the emergency department (ED) more frequently than the general population. Additionally, cancer patients are more likely to require a repeat ED visit within 7 days of a preceding ED discharge (bounce back). This may be a marker of inadequate care or missed diagnosis. We designed this study to evaluate whether there are differences in bounce-back rates among cancer patients of different races/ethnicities. Methods: We performed a retrospective cohort study to compare all cancer-related ED visits in California based on race/ethnicity using the Office of Statewide Health Planning and Development (OSHPD) database. We queried all cancer-related ED visits in 2016 among patients ≥18 years and recorded general demographics. Our outcome measures were bounce-back rate and admission rate on the second ED visit. All data were analyzed using SPSS software and descriptive statistics are reported. Results: In 2016, there were 73,465 patients with 103,523 cancer-related ED discharges that met study inclusion criteria. 18% (18,491 visits) of these visits resulted in a bounce-back (versus 13.3% in the general ED population). African American patients had the highest bounce-back rate at 19.5%, followed by Hispanics (18.9%), Non-Hispanic Whites (17.3%) and Asians (17%). We observed an inverse trend in admission rates on the bounce-back visit, with Asian patients having the highest admission rate (40.5%), followed by Non-Hispanic Whites (37.7%), Hispanics (35.1%), and African Americans (32.5%). This is in the context of an overall admission rate of 36.7%, and a high mortality rate on the bounce-back visit of 8.4%. All groups were similar with respect to age, gender, and disease burden. Conclusions: Overall, we observed that African Americans and Hispanics returned to the ED at rates above average, which may be a marker of inadequate care or misdiagnosis. Furthermore, these groups were discharged at a higher frequency on the second visit, despite the high mortality associated with a bounce-back visit. Further investigation is needed to identify actionable targets to improve the emergency cancer care of all races/ethnicities.