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Persistent inequalities in unplanned hospitalisation among colon cancer patients across critical phases of their care pathway, England, 2011–13

Research output: Contribution to journalArticle

Camille Maringe, Bernard Rachet , Georgios Lyratzopoulos, Francisco Javier Rubio

Original languageEnglish
Number of pages7
JournalBritish Journal of Cancer
Early online date15 Aug 2018
DOIs
Publication statusE-pub ahead of print - 15 Aug 2018

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Abstract

Background
Reducing hospital emergency admissions is a key target for all modern health systems.

Methods
We analysed colon cancer patients diagnosed in 2011–13 in England. We screened their individual Hospital Episode Statistics records in the 90 days pre-diagnosis, the 90 days post-diagnosis, and the 90 days pre-death (in the year following diagnosis), for the occurrence of hospital emergency admissions (HEAs).

Results
Between a quarter and two thirds of patients experience HEA in the three 90-day periods examined: pre-diagnosis, post-diagnosis and before death. Patients with tumour stage I-III from more deprived backgrounds had higher proportions of HEAs than less deprived patients during all studied periods. This remains even after adjusting for differing distributions of risk factors such as age, sex, comorbidity and stage at diagnosis.

CONCLUSIONS
Although in some cases HEAs might be unavoidable or even appropriate, the proportion of HEAs varies by socioeconomic status, even after controlling for the usual patient factors, suggestive of remediable causes of excess emergency healthcare utilisation in patients belonging to higher deprivation groups. Future inquiries should address the potential role of clinical complications, sub-optimal healthcare administration, premature discharge or a lack of social support as potential explanations for these patterns of inequality.

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