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Background

Individuals with cancer are more likely to visit an emergency department (ED) for issues both related and unrelated to their cancer than individuals without cancer, but data are lacking regarding what subpopulations are most vulnerable. Here, we assessed the characteristics of patients with pancreas cancer across the Northwell Health system who had multiple ED visits.

Methods

An IRB-approved retrospective chart review of patients with pancreas cancer diagnosed between 2015 through 2021 was conducted. Patients with > 3 ED visits were defined as high utilization and patients with 0 ED visits were defined as low utilization. Demographic and clinical features were recorded. Median income was extrapolated by zip code using data from the U.S. Census Bureau. Generalized logistic regression models were constructed to analyze characteristics associated with high ED utilization.

Results

The cohort consisted of 658 patients, among whom 181 individuals met criteria for high utilization and 140 met criteria for low utilization. Stage, age, gender, ethnicity, history of pancreatitis, median income, preferred language, establishment with primary care provider, and establishment with medical oncologist had no significant association with high utilization. Race (OR 2.8, P=0.002) and substance abuse (OR 4.43, P=0.02) were the strongest predictors of high ED utilization. We observed that 14% of the individuals who were Black had a history of substance abuse.

Conclusions

Our analysis identified a striking and concerning association between high utilization of the ED and patients who are Black or who have a history of substance abuse. Substance abuse may contribute to high ED utilization among Black Americans; however, 86% had no history of substance abuse, suggesting that other causal factors are at play. These results compel further investigation into these casual factors to guide the development of health equity interventions to address these disparities.

Read an interview about the study here.