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Yano EM, Wang M, Saigal C, Litwin M, and the. Urologic Disease Burden in the U.S.: Veterans Users of VA Health Care. Paper presented at: AcademyHealth Annual Research Meeting; 2003 Jun 26; Nashville, TN.
RESEARCH OBJECTIVE:To determine the disease burden of urologic conditions among veteran users of VA health care services and to assess variations by region and selected sociodemographic characteristics.STUDY DESIGN:We applied expert-designed diagnosis clusters to establish four patient cohorts: (1) benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), (2) urolithiasis (or kidney stones) (KS), (3) urinary tract infections (UTI), and (4) urinary incontinence (UI). We identified patients with qualifying diagnosis codes associated with outpatient visits from October 1, 2000 through September 30, 2001 (FY 2001) in the national VA Outpatient Clinic (OPC) file thereby generating case counts for each diagnostic category. We identified the base population at risk in the same year (males 40+ for BPH; male and female patients 18+ for other conditions) and subsequently for each risk category (i.e., age, gender, race-ethnicity, insurance status, region). We calculated prevalence rates as the number of unique cases per 100,000 unique outpatients.POPULATION STUDIED: All U.S. veterans age 18 and older with at least 1 outpatient visit in a VA health care facility in FY 2001 (n = 3,691,519).PRINCIPAL FINDINGS:Among veteran users of VA health care services, the prevalence among patients with a primary diagnosis of BPH/LUTS was 4,811 cases per 100,000 outpatients; 605 KS cases per 100,000; 4,625 female and 1,719 male UTIs per 100,000, respectively; and 2,161 female and 515 male UIs per 100,000. Prevalence based on all-diagnoses resulted in significantly higher case counts for each condition: 136% higher for BPH/LUTS, 64% higher for KS, 30% higher for female UTIs, 36% higher for male UTIs, 74% higher for female UI and 188% higher for male UI (all p < .0001). BPH prevalence increased linearly with age (from 808 to 7,136 per 100,000 for 40-44 vs. 85+ age groups), as did UI prevalence (from 87 to 1,365 per 100,000 for < 25 vs. 85+ age groups among men). KS prevalence peaked for 55-64 year olds (838/100,000). UTI prevalence did not vary by age, although 85+ prevalence jumped from 30-50%. Significant regional variations exist, but not uniformly among these urologic conditions (e.g., higher BPH prevalence in the East; higher KS and female UTI in the South and West).CONCLUSIONS:Overall, the prevalence of urologic conditions, such as BPH and urinary incontinence, is high among veterans who use the VA system for care, with prevalence estimates based on primary diagnosis significantly underestimating the disease burden among veterans. The aging of veteran users will only further increase the urologic disease burden.IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: This study represents the first national assessment of the disease burden of common urologic conditions among veteran users of the VA health care system. Designing chronic care systems in VA settings that adequately address their general and subspecialty needs and foster guideline-concordant care may provide models for other care settings.