Medical Attendance for Lower Urinary Tract Symptoms Is Associated with Subsequent Increased Risk of Outpatient Visits and Hospitalizations Based on a Nationwide Population-Based Database

Abstract

IntroductionLower urinary tract symptoms (LUTS), which encompass storage, voiding, and postmicturition symptoms, are highly prevalent and recognized globally. Based on a nationwide population-based database, this study tests the hypothesis that medical attendance for LUTS is associated with a subsequent increase in the number of outpatient visits and hospitalizations, with differences among medical specialties and age groups.MethodsParticipants were selected from a random population sample of approximately one million people as a representative cohort of National Health Insurance (NHI) enrollees in Taiwan. Participants had at least three outpatient service claims with a coding of LUTS during the recruitment period 2001–2004. Both the LUTS group and non-LUTS control group were monitored for subsequent outpatient visits and hospitalizations, excluding LUTS-related healthcare services, for 2 years following the index date. The results were categorized based on medical specialty and age group.ResultsThe outpatient visit rates (no. per person-year) and adjusted incidence rate ratios (IRRs) (95% confidence interval (CI) were significantly higher in urology (4.51, 95%CI 4.15–4.91) and gynecology (1.82, 95%CI 1.76–1.89) for the LUTS group. They were also significantly high in other departments, including internal medicine (1.25), general practice (1.13), Chinese medicine (1.77), family medicine (1.19), surgery (1.38), and psychiatry (1.98). Similarly, the hospitalization rate (no. per 1000 person-year) and adjusted IRRs (95% CI) were significantly higher in urology (5.50, 95% CI = 4.60–6.50) and gynecology (1.60, 95% CI = 1.35–1.90), as well as in internal medicine (1.55) and surgery (1.56), but not in psychiatry (1.12). Furthermore, the IRRs differed among 3 age groups.ConclusionsA significantly higher number of outpatient visits and hospitalizations were observed for individuals with LUTS, compared to the control group, and the effects differed with the advancement of age. This study broadens understanding of LUTS by viewing their impact on healthcare services with multiple and overlapping systems, rather than considering them exclusively as symptoms of traditional diseases of the bladder and urethra.

Risk of Hospitalization for Acute Cardiovascular Events among Subjects with Lower Urinary Tract Symptoms: A Nationwide Population-Based Study

“…In accordance with our study series on LUTS [1], [11], we scrutinized all the relevant ICD-9-CM codes and defined the following categories of codes for service claims as LUTS: (A) storage symptoms, including hypertonicity of bladder (ICD-9-CM code 596.51), frequency and polyuria (788.4), stress urinary incontinence in women (625.6) and men (788.32), urgent incontinence (788.31), nocturnal enuresis (788.36), nocturia (788.43), mixed incontinence (788.33); (B) voiding symptoms, including retention of urine (788.2), splitting & slowing of urine stream (788.6), and post-void dribbling (788.35); and (C) benign prostate hyperplasia (BPH) in men (600). Because LUTS are inseparable from clinical BPH [12], men with a BPH code, regardless of corresponding codes for storage/voiding symptoms or not, were all categorized as LUTS.…”

“…By 2009 more than 99% of the total population in Taiwan has been covered by the compulsory and universal NHI since its implementation in March 1995. The details of NHIRD were described in our previous studies [1], [11]. In brief, from the registration files and NHI claims data between 2000 and 2009, a random sample of one million enrollees (approximately 5% of Taiwan's population) has been established as a representative cohort.…”

Healthcare utilization and costs in patients with benign prostatic hyperplasia: a population-based study

“…Our findings are consistent with results of a study by Wu et al . which reported that patients with BPH/lower urinary tract symptoms (LUTSs) had higher rates of outpatient visits and hospitalization than a comparison group 6. In addition, another similar study reported that patients with LUTSs were associated with increased resource use in terms of emergency room visits, medical provider visits, and hospitalizations than were those without LUTSs 7…”

“…Wu et al . reported that a poor quality of life among people with BPH/LUTSs can lower the threshold of outpatient visits and hospitalization requests 6. Those potential medical conditions may increase the opportunity to use urological and nonurological health services among patients with BPH.…”

Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort

“…No significant differences exist in the age, gender, or insured amount distributions between patients in our data and the original NHIRD with p value = 0.187 [ 10 ]. The NHIRD has been used by many researchers [ 11 ] for dozens of published studies. The Institutional Review Board (IRB) of Chi Mei Foundation Hospital approved this study and waived the requirement of informed consent because the datasets in the NHIRD have no identifiable personal information.…”