Socioeconomic status and recurrent emergency visits amongst chemotherapy patients.

Abstract

106 Background: Multiple studies have found that cancer patients undergoing cytotoxic chemotherapy have a high rate of emergency department (ED) utilization throughout the course of their treatment and up to 20% of patients have recurrent ED visits. We assessed the effect of socioeconomic status (SES) on recurrent ED visits for infectious causes amongst chemotherapy patients. Methods: All patients who visited the Peel Regional Cancer Centre ED within 30 days of receiving cytotoxic chemotherapy between 04/12 - 3/13 were identified. Patients were included in the study if their primary reason for presentation was either fever or infection. Postal codes were cross-matched against 2011 census data from Statistics Canada to obtain estimates of income, education, and occupation. The impact of SES factors on the likelihood of multiple ED visits was analyzed. Results: 239 patients with at least 1 visit to the ED for infection were identified. Of these patients 103 (43.1%) had recurrent ED visits. Patients from areas with a higher proportion of arts, sports, culture, recreation, agriculture, and natural resources employment had a significantly (p<0.02) lower incidence of recurrent visits compared to single visits. Patients from areas with a lower proportion of healthcare, natural sciences, and applied sciences employment had a significantly (p<0.04) lower incidence of recurrent visits compared to single visits. Patients from areas with a greater proportion of people for whom the highest education completed was only high school had a significantly (p= 0.01) lower incidence of recurrent visits compared to single visits. Conclusions: Instead of observing a higher rate of ED visits for infection among patients with lower SES, patients residing in areas of lower education or in areas with a higher proportion of employment in fields associated with lower SES were less likely to have recurrent visits. It remains unclear if this represents decreased adherence to fever recommendations in patients with lower SES or over usage of ED services in patients with higher SES. Further studies are planned to better understand these observations to help inform educational interventions and community-based monitoring aimed at decreasing the risk of ED visits.