Browsing by Author "Lyratzopoulos, Georgios"

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    Emergency department involvement in the diagnosis of cancer among older adults: a SEER-Medicare study
    (Oxford University Press, 2024) Thompson, Caroline A.; Sheridan, Paige; Metwally, Eman; Peacock Hinton, Sharon; Mullins, Megan A.; Dillon, Ellis C.; Thompson, Matthew; Pettit, Nicholas; Kurian, Allison W.; Pruitt, Sandi L.; Lyratzopoulos, Georgios; Emergency Medicine, School of Medicine
    Background: Internationally, 20% to 50% of cancer is diagnosed through emergency presentation, which is associated with lower survival, poor patient experience, and socioeconomic disparities, but population-based evidence about emergency diagnosis in the United States is limited. We estimated emergency department (ED) involvement in the diagnosis of cancer in a nationally representative population of older US adults, and its association with sociodemographic, clinical, and tumor characteristics. Methods: We analyzed Surveillance, Epidemiology, and End Results Program-Medicare data for Medicare beneficiaries (≥66 years old) with a diagnosis of female breast, colorectal, lung, and prostate cancers (2008-2017), defining their earliest cancer-related claim as their index date, and patients who visited the ED 0 to 30 days before their index date to have "ED involvement" in their diagnosis, with stratification as 0 to 7 or 8 to 30 days. We estimated covariate-adjusted associations of patient age, sex, race and ethnicity, marital status, comorbidity score, tumor stage, year of diagnosis, rurality, and census-tract poverty with ED involvement using modified Poisson regression. Results: Among 614 748 patients, 23% had ED involvement, with 18% visiting the ED in the 0 to 7 days before their index date. This rate varied greatly by tumor site, with breast cancer at 8%, colorectal cancer at 39%, lung cancer at 40%, and prostate cancer at 7%. In adjusted models, older age, female sex, non-Hispanic Black and Native Hawaiian or Other Pacific Islander race, being unmarried, recent year of diagnosis, later-stage disease, comorbidities, and poverty were associated with ED involvement. Conclusions: The ED may be involved in the initial identification of cancer for 1 in 5 patients. Earlier, system-level identification of cancer in non-ED settings should be prioritized, especially among underserved populations.
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    Registry versus claims-based index dates for studies of cancer diagnosis in administrative data
    (Springer, 2025) Soppe, Sarah E.; Peacock Hinton, Sharon; Halula, Jamie C.; Lund, Jennifer L.; Baggett, Chris D.; Pruitt, Sandi L.; Mullins, Megan A.; Dillon, Ellis C.; Barclay, Matthew E.; Thompson, Matthew; Pettit, Nicholas; Lyratzopoulos, Georgios; Thompson, Caroline A.; Emergency Medicine, School of Medicine
    Purpose: Studies of healthcare encounters leading to cancer diagnosis have increased over recent years. While some studies examine healthcare utilization before the cancer registry date of diagnosis, relevant pre-diagnosis interactions are not always immediately prior to this date due to date abstraction guidelines. We evaluated agreement of a registry date with a claims-based index and examined Emergency Department (ED) involvement in cancer diagnosis as an example of possible pre-diagnostic healthcare misclassification that could arise from improper date choice. Methods: We implemented an algorithm to define a claims-based index as the date of the earliest International Classification of Diseases code for the cancer in Medicare and estimated agreement with the date of diagnosis from a North Carolina registry for patients diagnosed aged 66 or older with 16 cancer types from 2008 to 2017 (n = 92,056). We then classified whether each cancer was initially diagnosed through care originating in the ED using each date. Results: The index date was identical to the cancer registry date for 47% of patients and preceded the registry date for 28%, with extent of agreement varying by cancer- and patient-specific characteristics. Agreement in ED-involved diagnosis classification using each date varied by cancer site, with sensitivity of classifications using the registry date relative to the index having a minimum of 86% for prostate and kidney cancer. Conclusion: Studies assessing healthcare utilization proximal to cancer diagnosis should carefully consider the relevant assessment window and be aware that the use of cancer registry versus claims-based dates may impact variable classification.