Jacobi Medical Center The Bronx, NY, United States
Maria Gabriela Rubianes Guerrero, MD1, Michail Kladas, MD2, Osayande Osagiede, MD, MPH1, Donald P. Kotler, MD1 1Jacobi Medical Center, Bronx, NY; 2North Central Bronx Hospital, Bronx, NY
Introduction: Public hospitals serve two general populations. They provide continuity care for working-class patients as well as emergency and inpatient care for ill patients, regardless of the ability to pay. We compared demographic and disease characteristics of colorectal cancer (CRC) in continuity patients (C) and those without prior primary care at our institution (NC).
Methods: A de-identified database of CRC patients treated at Jacobi Medical Center and North Central Bronx Hospital, from January 1, 2016, to June 1, 2021, was constructed and demographic and clinical data were extracted from the electronic health record. A C patient was seen at least once in a primary care setting (Family Medicine, Internal Medicine, ObGyn) within 5 years of being diagnosed with CRC. Variables of interest included age, sex, race, BMI, cigarette smoking, diabetes, indication (screening vs diagnostic), right vs left colon (separated at splenic flexure), and non-advanced (Stages 0-2) vs advanced (Stages 3-4). Fisher exact test was used to compare stage, sex, presence of symptoms, and lesion location between the two groups. Two tailed t test was used to compare BMI and age.
Results: 292 patients were included, 52% were C while 48% were NC. Mean age was 62, there were 55% women and 45% men, and around 75% percent were African American or Hispanic. Mean BMI was 27.8, 35% were diabetic, and 54.4% had a history of cigarette smoking. Around 80% of patients had signs or symptoms at diagnosis.
There was a significant difference in disease stage between C and NC; 38.5% of C had advanced CRC at diagnosis versus 71.2% in NC (p< 0.001). Signs or symptoms of CRC were found in 69% of C vs 93% of NC (p < 0.001). Mean BMI at diagnosis was 28.6 (SD 6.2) for C vs 26.8 (SD 5.9) for NC (p < 0.05). Differences in sex, age, and location between C and NC were not statistically significant.
Discussion: In this retrospective study of CRC screening in a public hospital in New York City, the absence of primary care was associated with an increased risk of advanced disease at diagnosis. While adherence to CRC screening may be incomplete, access to primary care may allow diagnosis in symptomatic cases to be made earlier than otherwise, even in the absence of CRC screening. These data also illustrate the dilemma that the benefits of preventive medicine are limited to those who participate. Separate approaches are needed to increase participation in C and NC.
Maria Gabriela Rubianes Guerrero indicated no relevant financial relationships.
Michail Kladas indicated no relevant financial relationships.
Osayande Osagiede indicated no relevant financial relationships.
Donald Kotler indicated no relevant financial relationships.
Maria Gabriela Rubianes Guerrero, MD1, Michail Kladas, MD2, Osayande Osagiede, MD, MPH1, Donald P. Kotler, MD1. P1300 - Heterogeneity of Colorectal Cancer Patients Managed in a Public Hospital in New York City, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.