Elsevier

Urology

Volume 72, Issue 3, September 2008, Pages 498-502
Urology

Ambulatory & Office Urology
Patterns of Hematuria Referral to Urologists: Does a Gender Disparity Exist?

https://doi.org/10.1016/j.urology.2008.01.086Get rights and content

Objectives

To examine the referral patterns of hematuria within a nonprofit healthcare organization to determine the factors that influence referral. Hematuria continues to be an important sign of urologic disease, including urothelial malignancy. An increasing awareness of gender differences in tumor stage at bladder cancer presentation has led to speculation about delayed referral and diagnosis in women. However, little is known about the referral patterns of hematuria and whether gender differences exist.

Methods

The insurance records were examined from 926 consecutive adult health plan participants (559 men and 367 women) with newly diagnosed hematuria from 1998 to 2002. The patterns of urologic referral were evaluated. A Cox multivariate regression model was used to examine the relationship between urologic referral and the relevant variables.

Results

Overall, 263 men (47%) and 102 women (28%) were referred for urologic evaluation of hematuria, with a median follow-up of 27 and 26 months, respectively. Referral was initiated by the primary care physician in 80% of the cohort. Increased urologic referral was associated with advancing age, repeated hematuria, provider type, and male gender. The adjusted hazard ratio of male referral was 1.65 (95% confidence interval 1.31-2.08) compared with female referral.

Conclusions

Primary care physicians practicing in a managed care setting are less likely to refer women for a urologic evaluation of new or first recurrent episodes of hematuria than to refer men in all patient age categories, except for 40-49 years. This apparent gender disparity could result in unequal access of specialty evaluation and could potentially delay the diagnosis of important urologic conditions.

Section snippets

Data Source

The data were obtained from a medium-size, university-affiliated, nonprofit, managed care organization in the Midwest. The plan provided a variety of healthcare products, including a commercial and university health maintenance organization, a commercial point-of-service plan, Medicaid, and Medicare+Choice. As approved by the institutional review board, the participants with newly diagnosed hematuria from 1998 to 2002 were identified using the International Classification of Diseases, 9th

Results

During the study period, 926 consecutive patients met the entry criteria, including 559 men and 367 women, enrolled for a median of 5.2 years (range 1-17) before their diagnosis. The median enrollment times were similar between men and women (P = .63). The mean age of the men and women was 49 ± 17 years and 46 ± 16 years, respectively. The cohort demographics are summarized in Table 1. Of the male and female participants, 47% and 28% were referred for urologic consultation, respectively. A

Comment

In most patients, urologic evaluation was deemed unnecessary for a primary diagnosis of hematuria, with only 39% of patients requiring referral. The factor having the greatest influence on referral was the multiplicity of hematuria-related office visits, an indicator of a significant benign or malignant genitourinary condition.3 Advancing age also influenced urologic referral, likely prompted by the awareness of a substantially increased risk of genitourinary malignancies in persons >50-60

Conclusions

The findings from the present study suggest that a gender inequity in access to specialty evaluation of hematuria might exist. Primary care physicians practicing in a managed care setting were less likely to refer women for urologic evaluation of new or first recurrent episodes of hematuria. This disparity was even present for participants >60 years of age, when bladder cancer and other urologic malignancies are more common. This could potentially contribute to a delayed diagnosis of

References (22)

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This study was supported by the Robert and Elizabeth Teeter Bladder Cancer Fund.

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