Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy

Richard S. Matulewicz*, Alysen L. Demzik, John Oliver DeLancey, Oana Popescu, Danil V. Makarov, Joshua J Meeks

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: Disparities in survival for bladder and kidney cancer among the genders and patients with varying insurance coverage have been identified. Microhematuria (MH), a potential early clinical sign of genitourinary malignancy, should prompt a standardized diagnostic evaluation. However, many patients do not complete a full evaluation and may be at risk of a missed or delayed identification of genitourinary pathology. Methods: Patients 35 and older with a new diagnosis of MH between 2007 and 2015 were retrospectively identified at a large health system. Our primary outcome of interest was completion of cystoscopy and imaging. Regression modeling was used to assess associations between gender and insurance status with completion of a MH evaluation, adjusted for clinical factors, urinalysis data, and patient demographics. Results: Of 15,161 patients with MH, only 1,273 patients (8.4%) completed upper tract imaging and a cystoscopy; 899 (5.9%) within 1 year. Median time to imaging was 75days and 68.5days for cystoscopy. Of those with an incomplete evaluation, 23.7% underwent cystoscopy and 76.3% underwent imaging. Male gender, private insurance, and increased MH severity on UA were associated with a complete evaluation. More patients who completed an evaluation were diagnosed with bladder (4.8% vs. 0.3%) and kidney cancer (3.1% vs. 0.4%) when compared to those who did not. Conclusion: Few patients complete a timely evaluation of MH. Women and underinsured patients are disproportionately less likely to complete a work-up for microhematuria and this may have downstream implications for diagnosis.

Original languageEnglish (US)
Pages (from-to)300.e1-300.e7
JournalUrologic Oncology: Seminars and Original Investigations
Volume37
Issue number5
DOIs
StatePublished - May 1 2019

Fingerprint

Cystoscopy
Neoplasms
Insurance Coverage
Kidney Neoplasms
Urinalysis
Insurance
Urinary Bladder Neoplasms
Urinary Bladder
Demography
Pathology
Survival
Health

Keywords

  • Bladder cancer
  • Cystoscopy
  • Hematuria
  • Kidney cancer
  • Microhematuria

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Matulewicz, Richard S. ; Demzik, Alysen L. ; DeLancey, John Oliver ; Popescu, Oana ; Makarov, Danil V. ; Meeks, Joshua J. / Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy. In: Urologic Oncology: Seminars and Original Investigations. 2019 ; Vol. 37, No. 5. pp. 300.e1-300.e7.
@article{3c2828d81c32430ca2f27f55b8ad1749,
title = "Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy",
abstract = "Introduction: Disparities in survival for bladder and kidney cancer among the genders and patients with varying insurance coverage have been identified. Microhematuria (MH), a potential early clinical sign of genitourinary malignancy, should prompt a standardized diagnostic evaluation. However, many patients do not complete a full evaluation and may be at risk of a missed or delayed identification of genitourinary pathology. Methods: Patients 35 and older with a new diagnosis of MH between 2007 and 2015 were retrospectively identified at a large health system. Our primary outcome of interest was completion of cystoscopy and imaging. Regression modeling was used to assess associations between gender and insurance status with completion of a MH evaluation, adjusted for clinical factors, urinalysis data, and patient demographics. Results: Of 15,161 patients with MH, only 1,273 patients (8.4{\%}) completed upper tract imaging and a cystoscopy; 899 (5.9{\%}) within 1 year. Median time to imaging was 75days and 68.5days for cystoscopy. Of those with an incomplete evaluation, 23.7{\%} underwent cystoscopy and 76.3{\%} underwent imaging. Male gender, private insurance, and increased MH severity on UA were associated with a complete evaluation. More patients who completed an evaluation were diagnosed with bladder (4.8{\%} vs. 0.3{\%}) and kidney cancer (3.1{\%} vs. 0.4{\%}) when compared to those who did not. Conclusion: Few patients complete a timely evaluation of MH. Women and underinsured patients are disproportionately less likely to complete a work-up for microhematuria and this may have downstream implications for diagnosis.",
keywords = "Bladder cancer, Cystoscopy, Hematuria, Kidney cancer, Microhematuria",
author = "Matulewicz, {Richard S.} and Demzik, {Alysen L.} and DeLancey, {John Oliver} and Oana Popescu and Makarov, {Danil V.} and Meeks, {Joshua J}",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.urolonc.2019.01.007",
language = "English (US)",
volume = "37",
pages = "300.e1--300.e7",
journal = "Urologic Oncology",
issn = "1078-1439",
publisher = "Elsevier Inc.",
number = "5",

}

Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy. / Matulewicz, Richard S.; Demzik, Alysen L.; DeLancey, John Oliver; Popescu, Oana; Makarov, Danil V.; Meeks, Joshua J.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 37, No. 5, 01.05.2019, p. 300.e1-300.e7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Disparities in the diagnostic evaluation of microhematuriaand implications for the detection of urologic malignancy

AU - Matulewicz, Richard S.

AU - Demzik, Alysen L.

AU - DeLancey, John Oliver

AU - Popescu, Oana

AU - Makarov, Danil V.

AU - Meeks, Joshua J

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Introduction: Disparities in survival for bladder and kidney cancer among the genders and patients with varying insurance coverage have been identified. Microhematuria (MH), a potential early clinical sign of genitourinary malignancy, should prompt a standardized diagnostic evaluation. However, many patients do not complete a full evaluation and may be at risk of a missed or delayed identification of genitourinary pathology. Methods: Patients 35 and older with a new diagnosis of MH between 2007 and 2015 were retrospectively identified at a large health system. Our primary outcome of interest was completion of cystoscopy and imaging. Regression modeling was used to assess associations between gender and insurance status with completion of a MH evaluation, adjusted for clinical factors, urinalysis data, and patient demographics. Results: Of 15,161 patients with MH, only 1,273 patients (8.4%) completed upper tract imaging and a cystoscopy; 899 (5.9%) within 1 year. Median time to imaging was 75days and 68.5days for cystoscopy. Of those with an incomplete evaluation, 23.7% underwent cystoscopy and 76.3% underwent imaging. Male gender, private insurance, and increased MH severity on UA were associated with a complete evaluation. More patients who completed an evaluation were diagnosed with bladder (4.8% vs. 0.3%) and kidney cancer (3.1% vs. 0.4%) when compared to those who did not. Conclusion: Few patients complete a timely evaluation of MH. Women and underinsured patients are disproportionately less likely to complete a work-up for microhematuria and this may have downstream implications for diagnosis.

AB - Introduction: Disparities in survival for bladder and kidney cancer among the genders and patients with varying insurance coverage have been identified. Microhematuria (MH), a potential early clinical sign of genitourinary malignancy, should prompt a standardized diagnostic evaluation. However, many patients do not complete a full evaluation and may be at risk of a missed or delayed identification of genitourinary pathology. Methods: Patients 35 and older with a new diagnosis of MH between 2007 and 2015 were retrospectively identified at a large health system. Our primary outcome of interest was completion of cystoscopy and imaging. Regression modeling was used to assess associations between gender and insurance status with completion of a MH evaluation, adjusted for clinical factors, urinalysis data, and patient demographics. Results: Of 15,161 patients with MH, only 1,273 patients (8.4%) completed upper tract imaging and a cystoscopy; 899 (5.9%) within 1 year. Median time to imaging was 75days and 68.5days for cystoscopy. Of those with an incomplete evaluation, 23.7% underwent cystoscopy and 76.3% underwent imaging. Male gender, private insurance, and increased MH severity on UA were associated with a complete evaluation. More patients who completed an evaluation were diagnosed with bladder (4.8% vs. 0.3%) and kidney cancer (3.1% vs. 0.4%) when compared to those who did not. Conclusion: Few patients complete a timely evaluation of MH. Women and underinsured patients are disproportionately less likely to complete a work-up for microhematuria and this may have downstream implications for diagnosis.

KW - Bladder cancer

KW - Cystoscopy

KW - Hematuria

KW - Kidney cancer

KW - Microhematuria

UR - http://www.scopus.com/inward/record.url?scp=85060077688&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060077688&partnerID=8YFLogxK

U2 - 10.1016/j.urolonc.2019.01.007

DO - 10.1016/j.urolonc.2019.01.007

M3 - Article

VL - 37

SP - 300.e1-300.e7

JO - Urologic Oncology

JF - Urologic Oncology

SN - 1078-1439

IS - 5

ER -