MP6-16 GENDER, RACE, AND VARIATION IN THE WORKUP OF HEMATURIA

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2014MP6-16 GENDER, RACE, AND VARIATION IN THE WORKUP OF HEMATURIA Jeffrey Bassett, JoAnn Alvarez, Chaochen You, Tatsuki Koyama, Shenghua Ni, David Penson, and Daniel Barocas Jeffrey BassettJeffrey Bassett More articles by this author , JoAnn AlvarezJoAnn Alvarez More articles by this author , Chaochen YouChaochen You More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Shenghua NiShenghua Ni More articles by this author , David PensonDavid Penson More articles by this author , and Daniel BarocasDaniel Barocas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.250AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female gender and non-white race are predictive of a higher stage and worse survival in patients diagnosed with bladder cancer (BC). Hematuria is the most common sign of BC, yet fewer than half of patients with hematuria undergo the evaluation recommended by the American Urological Association. Our aim was to determine the association between gender, race, and receipt of a timely and complete evaluation of hematuria. METHODS We included Medicare A and B beneficiaries from the 5% sample who were diagnosed with incident hematuria by a primary care provider during an outpatient visit between January 2009 and June 2010. Patients with a pre-existing explanatory diagnosis or discontinuous coverage were excluded. Our primary endpoint was the completeness of hematuria evaluation in the 180 days after diagnosis, with the evaluation categorized as complete or either incomplete or absent based on the utilization of cystoscopy and abdomino-pelvic imaging. Generalized linear mixed models were used to examine the relationship between gender, race, and the completeness of hematuria evaluation adjusting for patient- and county-level covariates. RESULTS We identified 9,220 beneficiaries who met our study criteria. The evaluation was complete in 14% of patients, incomplete in 21% and absent in 65%.. In multivariable analyses, females were less likely than males to be seen by a urologist, to undergo a diagnostic procedure or imaging, or to have a complete workup (Figure 1). Race/ethnicity was not an independent predictor of hematuria evaluation. Completeness of the work-up was associated with the likelihood of a definitive urologic or renal diagnosis being rendered; an etiologic diagnosis was coded in 69% vs. 34% vs. 8% (p < 0.001), and a malignancy diagnosed in 28% vs. 2% vs. 0.3% of evaluations that were complete, incomplete, or absent, respectively (p < 0.001). CONCLUSIONS Our data demonstrate that female Medicare beneficiaries are less likely to undergo a hematuria evaluation and may therefore be less likely to receive a definitive urologic diagnosis, even when one is present. While race differences in BC outcomes cannot be attributed to differences in the quality of evaluation for hematuria, inadequate hematuria evaluation may contribute to the higher stage and worse outcomes for females diagnosed with BC. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e62-e63 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jeffrey Bassett More articles by this author JoAnn Alvarez More articles by this author Chaochen You More articles by this author Tatsuki Koyama More articles by this author Shenghua Ni More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...