Kim Edward K, Muñoz Jaclyn M, Hong Christopher X, Agrawal Surbhi, Kreines Fabiana M, Harvie Heidi S
Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
World J Urol. 2023 Mar;41(3):821-827. doi: 10.1007/s00345-023-04309-y. Epub 2023 Feb 6.
Urinary incontinence (UI) among women is under-recognized in primary care setting. We hypothesized that UI is, therefore, more commonly diagnosed by specialists. Our aim was to determine the rate of UI diagnosis by provider and patient demographics, and whether these factors affect the likelihood of UI diagnosis.
Retrospective study using electronic medical records from 2010 to 2019. Ambulatory patient encounters by adult females were identified. Encounters with new diagnosis of UI (stress, urgency, mixed, or unspecified) were identified using ICD 9 and 10 codes. The following data were extracted: diagnosing provider specialty and sex, patient age, BMI, race, estimated household income, insurance coverage and type, and primary care provider (PCP). Rate of UI diagnosis was calculated using proportions. Univariable comparison and multivariable logistic regression were performed.
576,110 patient encounters were captured. 14,378 patient encounters had UI diagnosis (2.5%). UI population had the following characteristics: Mean age of 60.1 ± 15.5 years, 65.6% identified as white, 75.7% had a PCP, and 87.9% had insurance. UI diagnosis rate was < 1% for PCPs. Multivariable logistic regression showed that urogynecologists and female providers were more likely to diagnose UI; patient demographics associated with UI diagnosis included older age, elevated BMI, white race, commercial insurance, and having a PCP. Estimated household income did not have a significant effect.
Diagnosis of UI is seldom made by PCPs. Race, insurance, and having a PCP may affect the likelihood of receiving UI diagnosis. Continued efforts to promote equity in recognizing UI may be warranted.
在初级保健环境中，女性尿失禁（UI）的问题未得到充分认识。因此，我们推测尿失禁更常由专科医生诊断。我们的目的是确定按医疗服务提供者和患者人口统计学特征划分的尿失禁诊断率，以及这些因素是否会影响尿失禁诊断的可能性。
采用回顾性研究，使用2010年至2019年的电子病历。确定成年女性的门诊患者就诊情况。使用ICD 9和10编码确定新诊断为尿失禁（压力性、急迫性、混合性或未明确类型）的就诊情况。提取以下数据：诊断医生的专业和性别、患者年龄、体重指数、种族、估计家庭收入、保险覆盖范围和类型，以及初级保健医生（PCP）。使用比例计算尿失禁诊断率。进行单变量比较和多变量逻辑回归分析。
共记录了576,110次患者就诊情况。14,378次患者就诊被诊断为尿失禁（2.5%）。尿失禁患者群体具有以下特征：平均年龄60.1±15.5岁，65.6%为白人，75.7%有初级保健医生，87.9%有保险。初级保健医生的尿失禁诊断率<1%。多变量逻辑回归分析表明，女性泌尿妇科医生和女性医疗服务提供者更有可能诊断尿失禁；与尿失禁诊断相关的患者人口统计学特征包括年龄较大、体重指数升高、白人种族、商业保险以及有初级保健医生。估计家庭收入没有显著影响。
初级保健医生很少诊断尿失禁。种族、保险以及有初级保健医生可能会影响尿失禁诊断的可能性。可能有必要继续努力促进在认识尿失禁方面的公平性。
