• Jeffrey C Bassett, JoAnn Alvarez, Tatsuki Koyama, Matthew Resnick, Chaochen You, Shenghua Ni, David F Penson, and Daniel A Barocas.
• Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN, 37232-2765, USA, jeffrey.c.bassett@kp.org.
• J Gen Intern Med. 2015 Apr 1; 30 (4): 440447440-7.

BackgroundFemale gender and black race are associated with delayed diagnosis and inferior survival in patients with bladder cancer.ObjectiveWe aimed to determine the association between gender, race, and evaluation of microscopic hematuria (an early sign of bladder cancer).Design And ParticipantsThis was a cohort study using a 5 % random sample of fee-for-service Medicare beneficiaries diagnosed with incident hematuria (International Classification of Diseases, Ninth Revision [ICD-9] code 599.7x) between January 2009 and June 2010 in a primary care setting. Beneficiaries with pre-existing explanatory diagnoses or genitourinary procedures were excluded.Main MeasuresThe main endpoint was completeness of the hematuria evaluation in the 180 days after diagnosis. Evaluations were categorized as complete, incomplete, or absent based on receipt of relevant diagnostic procedures and imaging studies.Key ResultsIn all, 9,211 beneficiaries met the study criteria. Hematuria evaluations were complete in 14 %, incomplete in 21 %, and absent in 65 % of subjects. Compared to males, females were less likely to have a procedure (26 vs. 12 %), imaging (41 vs. 30 %), and a complete evaluation (22 vs. 10 %) (p < 0.001 for each comparison). Receipt of a complete evaluation did not differ by race. Controlling for baseline characteristics, a complete evaluation was less likely in white women (OR, 0.40 [95 % CI, 0.35-0.46]) and black women (OR, 0.46 [95 % CI, 0.29-0.70]) compared to white men; no difference was found between black and white men.ConclusionsWomen are less likely than men to undergo a complete and timely hematuria evaluation, a finding likely relevant to women's more advanced stage at bladder cancer diagnosis. System-level process improvement between providers of urologic and primary care in the evaluation of hematuria may benefit women harboring malignancy.

23 keywords...

hide…