In the Veterans Affairs Healthcare System, estimates of urologic disease prevalence among males and females based only on primary diagnosis will significantly underestimate the true disease burden, say researchers in Los Angeles.
Dr. Jennifer T. Anger of the University of California at Los Angeles and colleagues analyzed reasons for urology-related outpatient visits to VA healthcare facilities in fiscal year 2001. Dr. Anger's team grouped the more than 3.5 million veterans who were seen into four cohorts by primary diagnosis: BPH or lower urinary tract symptoms, UTIs, urinary incontinence, and kidney stones.
According to the report in the July issue of Urology, there were 4,811 veterans with a primary diagnosis of BPH/lower urinary tract symptoms per 100,000, for a prevalence of 4.8%.
The prevalence of UTI was 4,265 per 100,000 female veterans, or 4.3%, and for male veterans, it was 1,719 visits per 100.000, or 1.7%.
The prevalence of urinary incontinence was 2,161 per 100,000 female veterans, or 2.2%, and 515 per 100,000 male veterans, or 0.5%.
The prevalence of kidney stones was 597 per 100,000 veterans, or 0.6%.
Prevalence rates for all four conditions were much higher when secondary diagnoses were included, the Los Angeles team said. "Prevalence estimates based on primary diagnosis, rather than secondary or 'any' diagnosis, significantly underestimated the disease burden among veterans," they write. For example, including patients for whom the urologic condition was not the main reason for their visit raised the prevalence of female UTI from 2.2% to 3.8% and the prevalence of BPH/lower urinary tract symptoms from 4.8% to 11.4%.
"Although we expected the prevalence of urologic conditions to be high among veterans who use the VA system for care, we found the burden of urologic disease among veterans to be comparable to other national data sets," Dr. Anger and colleagues report.
"The aging of veteran users will only further increase the urologic disease burden," they point out.
Urology 2008;72:37-41.
Reviewed by Ramaz Mitaishvili, MD
