An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care

William C. Livingood, Carmen Smotherman, Katryne Lukens-Bull, Petra Aldridge, D. Kraemer, David L. Wood, Carmine Volpe

Research output: Contribution to journalArticle

7 Citations (Scopus)


Reliance on emergency departments (EDs) by economically disadvantaged people for initial cancer diagnosis in place of primary care and early diagnosis and treatment is 1 obvious plausible explanation for cancer disparities. Claims data from a safety net hospital for the years 2009-2010 were merged with hospital tumor registry data to compare hospitalizations for ED-associated initial cancer diagnoses to non-ED associated initial diagnoses. The proportion of initial cancer diagnoses associated with hospital admissions through the ED was relatively high (32%) for all safety net hospital patients, but disproportionately higher for African Americans and residents of the impoverished urban core. Use of the ED for initial diagnosis was associated with a 75% higher risk of stage 4 versus stage 1 cancer diagnosis, and a 176% higher risk of dying during the 2-year study period. Findings from this study of ED use within a safety net hospital documented profound disparities in cancer care and outcomes with major implications for monitoring disparities, Affordable Care Act impact, and safety net hospital utilization.

Original languageEnglish
Pages (from-to)95-101
Number of pages7
JournalPopulation Health Management
Issue number2
Publication statusPublished - Apr 1 2016


ASJC Scopus subject areas

  • Health Policy
  • Leadership and Management
  • Public Health, Environmental and Occupational Health

Cite this

Livingood, W. C., Smotherman, C., Lukens-Bull, K., Aldridge, P., Kraemer, D., Wood, D. L., & Volpe, C. (2016). An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care. Population Health Management, 19(2), 95-101.