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Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study

BACKGROUND: Liver cancer is ranked fifth in incidence and second in mortality among cancers in Taiwan. Nevertheless, the Taiwan government does not screen for liver cancer in its free cancer screening and preventive health examination service. This study compared the differences in cancer stage and...

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Autores principales: Hsu, Tai-Yi, Ye, Jhu-Jing, Ye, Sih-Yun, Tseng, Hsiao-Yuan, Chou, Wen-Yu, Kung, Pei-Tseng, Tsai, Wen-Chen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906857/
https://www.ncbi.nlm.nih.gov/pubmed/36755232
http://dx.doi.org/10.1186/s12889-023-15218-5
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author Hsu, Tai-Yi
Ye, Jhu-Jing
Ye, Sih-Yun
Tseng, Hsiao-Yuan
Chou, Wen-Yu
Kung, Pei-Tseng
Tsai, Wen-Chen
author_facet Hsu, Tai-Yi
Ye, Jhu-Jing
Ye, Sih-Yun
Tseng, Hsiao-Yuan
Chou, Wen-Yu
Kung, Pei-Tseng
Tsai, Wen-Chen
author_sort Hsu, Tai-Yi
collection PubMed
description BACKGROUND: Liver cancer is ranked fifth in incidence and second in mortality among cancers in Taiwan. Nevertheless, the Taiwan government does not screen for liver cancer in its free cancer screening and preventive health examination service. This study compared the differences in cancer stage and survival between patients who received an initial liver cancer diagnosis in outpatient departments (OPDs) and those who received such a diagnosis in emergency departments (EDs). METHODS: This retrospective cohort study used the 2000–2016 National Health Insurance Database to obtain a sample from 2 million Taiwanese residents. To evaluate the effect of the utilization of the adult health examination offered to people aged ≥ 40 years, patients aged ≥ 40 years who received an initial liver cancer diagnosis between 2003 and 2015 were followed up until December 31, 2016. RESULTS: In total, 2,881 patients were included in this study. A greater proportion of cancer cases in the OPD group were non-advanced than those in the ED group (75.26% vs. 54.23%). Having stage C or D cancer, having a low monthly salary, and a Charlson comorbidity index score ≥ 8, not having hepatitis B, being divorced, and attending a non-public hospital as the primary care institution were risk factors for initial ED diagnosis. The risk of liver cancer-specific death among the ED group patients was 1.38 times that among the OPD group patients (adjusted hazard ratio = 1.38, 95% confidence interval [CI] = 1.14–1.68, P < 0.001). However, the use of health examination did not exert a significant effect on the likelihood of liver cancer diagnosis in an ED (adjusted odds ratio = 0.86, 95% CI = 0.61–1.21, P = 0.381). CONCLUSION: Government-subsidized health examinations are insufficient to prevent first-ever diagnosed liver cancers in EDs. Patients with liver cancers diagnosed in EDs had a higher risk of advanced stage and mortality. For early detection and treatment, the government may consider implementing liver cancer screening for high-risk and low-socioeconomic people.
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spelling pubmed-99068572023-02-08 Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study Hsu, Tai-Yi Ye, Jhu-Jing Ye, Sih-Yun Tseng, Hsiao-Yuan Chou, Wen-Yu Kung, Pei-Tseng Tsai, Wen-Chen BMC Public Health Research BACKGROUND: Liver cancer is ranked fifth in incidence and second in mortality among cancers in Taiwan. Nevertheless, the Taiwan government does not screen for liver cancer in its free cancer screening and preventive health examination service. This study compared the differences in cancer stage and survival between patients who received an initial liver cancer diagnosis in outpatient departments (OPDs) and those who received such a diagnosis in emergency departments (EDs). METHODS: This retrospective cohort study used the 2000–2016 National Health Insurance Database to obtain a sample from 2 million Taiwanese residents. To evaluate the effect of the utilization of the adult health examination offered to people aged ≥ 40 years, patients aged ≥ 40 years who received an initial liver cancer diagnosis between 2003 and 2015 were followed up until December 31, 2016. RESULTS: In total, 2,881 patients were included in this study. A greater proportion of cancer cases in the OPD group were non-advanced than those in the ED group (75.26% vs. 54.23%). Having stage C or D cancer, having a low monthly salary, and a Charlson comorbidity index score ≥ 8, not having hepatitis B, being divorced, and attending a non-public hospital as the primary care institution were risk factors for initial ED diagnosis. The risk of liver cancer-specific death among the ED group patients was 1.38 times that among the OPD group patients (adjusted hazard ratio = 1.38, 95% confidence interval [CI] = 1.14–1.68, P < 0.001). However, the use of health examination did not exert a significant effect on the likelihood of liver cancer diagnosis in an ED (adjusted odds ratio = 0.86, 95% CI = 0.61–1.21, P = 0.381). CONCLUSION: Government-subsidized health examinations are insufficient to prevent first-ever diagnosed liver cancers in EDs. Patients with liver cancers diagnosed in EDs had a higher risk of advanced stage and mortality. For early detection and treatment, the government may consider implementing liver cancer screening for high-risk and low-socioeconomic people. BioMed Central 2023-02-08 /pmc/articles/PMC9906857/ /pubmed/36755232 http://dx.doi.org/10.1186/s12889-023-15218-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Hsu, Tai-Yi
Ye, Jhu-Jing
Ye, Sih-Yun
Tseng, Hsiao-Yuan
Chou, Wen-Yu
Kung, Pei-Tseng
Tsai, Wen-Chen
Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study
title Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study
title_full Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study
title_fullStr Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study
title_full_unstemmed Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study
title_short Disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in Taiwan: a population-based study
title_sort disparities in the first-ever diagnosed liver cancers between the emergency department and outpatient department in taiwan: a population-based study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906857/
https://www.ncbi.nlm.nih.gov/pubmed/36755232
http://dx.doi.org/10.1186/s12889-023-15218-5
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