Stage at Presentation for Incarcerated Patients at a Single Urban Tertiary Care Center.
Kathryn S. Ivy,1 Kevin N. Griffith,2 Amy K. Rosen, PhD,1 Stephanie D. Talutis, MD,1 David B. McAneny, MD,1 Matthew H. Kulke, MD,1 Jennifer F. Tseng, MD, MPH,1 Teviah E. Sachs, MD, MPH1
1 Boston University School of Medicine 2 Boston University School of Public Health
Background: Incarcerated patients with cancer have worse outcomes and mortality than the general population, the reasons for which are poorly understood. We examined whether stage at presentation differed between incarcerated patients (IP) and the general population (GP) with cancer at an academic medical center.
Methods: We identified all patients presenting to our institution (01/01/2010 – 12/31/17) with a new diagnosis of cancer. Incarceration was identified by insurance billing records. Patients were compared on demographics, type of cancer and stage at presentation. Propensity score matching was used to adjust for demographic differences between IP and GP groups, with group outcomes compared using paired t-tests or Fisher exact tests.
Results: We identified 2950 patients, of whom 94 (3.2%) were IP. Demographics were similar between groups, although IP were more likely to be male (p<0.01) and younger age (p<0.01). The prevalence of cancers varied between groups (IP: hepatobiliary, bronchopulmonary, oropharyngeal, vs. GP: oropharyngeal, bronchopulmonary, prostate). Overall, IP were diagnosed at later AJCC stages than GP (p = 0.03). IP with hepatocellular cancer (HCC) were more often stage 2 or greater (83.3% vs. 52.8%; p=0.03).
Conclusion: IP with cancer are at higher risk for later stage presentation and, therefore, potentially worse outcomes and survival than GP. This difference is particularly strong in patients diagnosed with HCC, a malignancy amenable to screening. Despite the small sample size, this study suggests that IP are a high-risk group who may benefit from earlier and/or more targeted screening, with a goal of timelier diagnosis and potential to improve survival.
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