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

Tai-Yi Hsu; Jhu-Jing Ye; Sih-Yun Ye; Hsiao-Yuan Tseng; Wen-Yu Chou; Pei-Tseng Kung; Wen-Chen Tsai

doi:10.1186/s12889-023-15218-5

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

BMC Public Health. 2023 Feb 8;23(1):283. doi: 10.1186/s12889-023-15218-5.

Authors

Tai-Yi Hsu^{1

2}, Jhu-Jing Ye³, Sih-Yun Ye³, Hsiao-Yuan Tseng³, Wen-Yu Chou³, Pei-Tseng Kung^#^{4

5}, Wen-Chen Tsai^#⁶

Affiliations

¹ Department of Emergency Medicine, China Medical University & Hospital, Taichung, Taiwan R.O.C.
² Department of Public Health, China Medical University, Taichung, Taiwan R.O.C.
³ Department of Health Services Administration, China Medical University, 100, Sec. 1, Jingmao Rd., Beitun Dist, 406040, Taichung, Taiwan R.O.C.
⁴ Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan R.O.C.
⁵ Department of Healthcare Administration, Asia University, Taichung, Taiwan R.O.C.
⁶ Department of Health Services Administration, China Medical University, 100, Sec. 1, Jingmao Rd., Beitun Dist, 406040, Taichung, Taiwan R.O.C.. wctsai2011@gmail.com.

^# Contributed equally.

Abstract

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.

Keywords: Emergency department; Health examination; Liver cancer; Survival analysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Emergency Service, Hospital
Humans
Liver Neoplasms* / diagnosis
Liver Neoplasms* / epidemiology
Outpatients*
Retrospective Studies
Risk Factors
Taiwan / epidemiology

Grants and funding

DMR-108-226/China Medical University Hospital, Taiwan