Variation in the Diagnostic Evaluation among Persons with Hematuria: Influence of Gender, Race and Risk Factors for Bladder Cancer
| Autor: | Matthew J. Resnick, Tatsuki Koyama, Chaochen You, William J. Blot, Daniel A. Barocas, JoAnn Rudd Alvarez, Jeffrey C. Bassett, Jacob T. Ark, David F. Penson, Michael T. Mumma |
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| Rok vydání: | 2017 |
| Předmět: |
Diagnostic Imaging
medicine.medical_specialty Referral Urology 030232 urology & nephrology Diagnostic evaluation Medicare Odds 03 medical and health sciences Race (biology) Sex Factors 0302 clinical medicine Risk Factors Internal medicine medicine Humans Healthcare Disparities Referral and Consultation Hematuria African american Gynecology Bladder cancer medicine.diagnostic_test business.industry Cystoscopy medicine.disease United States Race Factors Urinary Bladder Neoplasms 030220 oncology & carcinogenesis Self Report business Cohort study |
| Zdroj: | Journal of Urology. 198:1033-1038 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2017.06.083 |
| Popis: | We sought to determine whether race, gender and number of bladder cancer risk factors are significant predictors of hematuria evaluation.We used self-reported data from SCCS (Southern Community Cohort Study) linked to Medicare claims data. Evaluation of subjects diagnosed with incident hematuria was considered complete if imaging and cystoscopy were performed within 180 days of diagnosis. Exposures of interest were race, gender and risk factors for bladder cancer.Of the 1,412 patients evaluation was complete in 261 (18%). On our adjusted analyses African American patients were less likely than Caucasian patients to undergo any aspect of evaluation, including urology referral (OR 0.72, 95% CI 0.56-0.93), cystoscopy (OR 0.67, 95% CI 0.50-0.89) and imaging (OR 0.75, 95% CI 0.59-0.95). Women were less likely than men to be referred to a urologist (OR 0.59, 95% CI 0.46-0.76). Also, although all patients with 2 or 3 risk factors had 31% higher odds of urology referral (OR 1.31, 95% CI 1.02-1.69), adjusted analyses indicated that this effect was only apparent among men.Only 18% of patients with an incident hematuria diagnosis underwent complete hematuria evaluation. Gender had a substantial effect on referral to urology when controlling for socioeconomic factors but otherwise it had an unclear role on the quality of evaluation. African American patients had markedly lower rates of thorough evaluation than Caucasian patients. Number of risk factors predicted referral to urology among men but it was otherwise a poor predictor of evaluation. There is opportunity for improvement by increasing the completion of hematuria evaluations, particularly in patients at high risk and those who are vulnerable. |
| Databáze: | OpenAIRE |
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