Melgaard Anna, Vestergaard Claus Høstrup, Kesmodel Ulrik Schiøler, Risør Bettina Wulff, Forman Axel, Zondervan Krina T, Nath Mintu, Ayansina Dolapo, Saunders Philippa T K, Horne Andrew W, Saraswat Lucky, Rytter Dorte
Research Unit of Epidemiology, Department of Public Health, Aarhus University, Aarhus C, Denmark.
Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus C, Denmark.
Hum Reprod. 2025 Feb 1;40(2):280-288. doi: 10.1093/humrep/deae273.
How does pre-diagnosis use of hospital care differentiate between women later diagnosed with endometriosis and age-matched controls without a diagnosis?
Women with hospital-diagnosed endometriosis had more frequent hospital contacts in the 10 years leading up to the diagnosis compared to women without a diagnosis of endometriosis, and the contacts were related to registered diagnoses in nearly all of the included ICD-10 chapters for the entire period.
Only a few studies have investigated the utilization of health care among women with endometriosis in the time before diagnosis, but current research shows that women with endometriosis have a higher utilization compared to women without diagnosed endometriosis. To our knowledge, no study has investigated the type of contact related to the higher utilization by using the ICD-10 diagnoses registered to the hospital contact.
STUDY DESIGN, SIZE, DURATION: This study was conducted as a national Danish registry-based case-control study of 129 696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Using density sampling, we identified 21 616 cases. Each case was matched on age at the date of diagnosis (index date) to five women without hospital-diagnosed endometriosis (n = 108 080) at the time of matching. The utilization and registered ICD-10 diagnoses related to the hospital contact were included for the 10 years before the index date.
The probability of having a high number of hospital contacts (six or more) was more common among women with endometriosis (68.6%) compared to women without endometriosis (55.7%) In general, women without endometriosis were more likely to have fewer than six contacts. The diagnoses registered to the contact among cases were related to a greater variety of ICD-10 chapters when compared to controls with the same number of contacts. For nearly all of the included ICD-10 chapters, women with endometriosis were more likely to have a diagnosis over the entire period compared to controls, with the only exception being in the chapter related to pregnancy.
LIMITATIONS, REASONS FOR CAUTION: Our results are only applicable for women with hospital-based diagnosed endometriosis since we were not able to include women diagnosed at the general practitioner or private gynecologists. We were not able to make a causal interpretation, as we do not have information on the onset of symptoms of the included diseases. The association may be overestimated due to detection bias. However, a sensitivity analysis only changed the results slightly, indicating a low risk of this bias.
This study is in accordance with previous studies on the subject, indicating that the utilization of health care prior to endometriosis is not necessarily restricted to endometriosis-related symptoms and that endometriosis can be associated with many other diseases. Future studies may explore hospital contacts and causes/diagnoses following the endometriosis diagnosis to further shed light on whether our results are due to a pattern of multiple pathologies or rather an expression of misdiagnoses among women with endometriosis before diagnosis.
STUDY FUNDING/COMPETING INTEREST(S): This study is supported by grants from the project Finding Endometriosis using Machine Learning (FEMaLe/101017562), which has received funding from The European Union's Horizon 2020 research and innovation program and Helsefonden (21-B-0141). A.W.H. received grant funding from NIHR, CSO, Roche Diagnostics, and Wellbeing of Women. A.W.H.'s institution received consultation fees from Theramex, Joii, Gesynta, and Gedeon Richter. A.W.H.'s institution received honoraria for lectures from Theramex and Gedeon Richter. A.W.H. is listed as co-inventor on a patent application (UK Patent App No. 2217921.2, International Patent App No. PCT/GB2023/053076). P.T.K.S.'s institution (University of Edinburgh) received consultation fees from Gesynta Pharma AB and BenevolentAI Bio Ltd. P.T.K.S's institution (University of Edinburgh) declares a patent application (UK Patent Application No. 2310300.5. Androgens in diagnostic strategies for endometriosis). P.T.K.S. is a treasurer of the World Endometriosis Society, Fellowship in the Royal Society of Edinburgh, and a Scientific Advisor of the Royal College of Obstetrics and Gynaecology.
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在诊断前使用医院护理的情况如何区分后来被诊断为子宫内膜异位症的女性与年龄匹配的未被诊断的对照女性？
与未被诊断为子宫内膜异位症的女性相比，被医院诊断为子宫内膜异位症的女性在诊断前的10年中与医院的接触更频繁，并且在整个时期内，几乎所有纳入的ICD - 10章节中的接触都与登记的诊断相关。
只有少数研究调查了子宫内膜异位症女性在诊断前的医疗保健利用情况，但目前的研究表明，与未被诊断为子宫内膜异位症的女性相比，子宫内膜异位症女性的利用率更高。据我们所知，尚无研究通过使用与医院接触相关登记的ICD - 10诊断来调查与更高利用率相关的接触类型。
研究设计、规模、持续时间：本研究作为一项基于丹麦全国登记处的病例对照研究，涉及129696名女性。病例为2000年1月1日至2017年12月31日期间首次在医院被诊断为子宫内膜异位症的女性。
参与者/材料、设置、方法：采用密度抽样，我们确定了21616例病例。每个病例在诊断日期（索引日期）的年龄与五名在匹配时未被医院诊断为子宫内膜异位症的女性（n = 108080）进行匹配。纳入索引日期前10年与医院接触相关的利用率和登记的ICD - 10诊断。
与没有子宫内膜异位症的女性（55.7%）相比，有子宫内膜异位症的女性有大量医院接触（六次或更多）的概率更高（68.6%）。一般来说，没有子宫内膜异位症的女性接触次数少于六次的可能性更大。与相同接触次数的对照组相比，病例组接触中登记的诊断与更多种类的ICD - 10章节相关。对于几乎所有纳入的ICD - 10章节，与对照组相比，患有子宫内膜异位症的女性在整个时期内更有可能有诊断，唯一的例外是与妊娠相关的章节。
局限性、谨慎的原因：我们的结果仅适用于在医院被诊断为子宫内膜异位症的女性，因为我们无法纳入在全科医生或私人妇科医生处被诊断的女性。由于我们没有关于所纳入疾病症状发作的信息，所以无法进行因果解释。由于检测偏倚，这种关联可能被高估。然而，敏感性分析仅使结果略有变化，表明这种偏倚的风险较低。
本研究与之前关于该主题的研究一致，表明子宫内膜异位症诊断前的医疗保健利用不一定局限于与子宫内膜异位症相关的症状，并且子宫内膜异位症可能与许多其他疾病相关。未来的研究可以探索子宫内膜异位症诊断后的医院接触以及病因/诊断，以进一步阐明我们的结果是由于多种病理模式还是子宫内膜异位症女性在诊断前误诊的表现。
研究资金/竞争利益：本研究由“使用机器学习寻找子宫内膜异位症”（FEMaLe/101017562）项目资助，该项目获得了欧盟地平线2020研究与创新计划和丹麦卫生基金会（21 - B - 0141）的资金。A.W.H.获得了英国国家卫生研究院、苏格兰首席科学家办公室、罗氏诊断公司和英国妇女健康基金会的资助。A.W.H.所在机构从Theramex、Joii、Gesynta和吉德昂·里奇特公司获得咨询费。A.W.H.所在机构从Theramex和吉德昂·里奇特公司获得讲座酬金。A.W.H.被列为一项专利申请（英国专利申请号2217921.2，国际专利申请号PCT/GB2023/053076）的共同发明人。P.T.K.S.所在机构（爱丁堡大学）从Gesynta Pharma AB和BenevolentAI Bio Ltd获得咨询费。P.T.K.S.所在机构（爱丁堡大学）申报了一项专利申请（英国专利申请号2310300.5. 雄激素在子宫内膜异位症诊断策略中的应用）。P.T.K.S.是世界子宫内膜异位症协会的财务主管、爱丁堡皇家学会会员以及皇家妇产科学院的科学顾问。
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