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Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study

STUDY QUESTION: Do women with endometriosis have higher utilization of primary and secondary healthcare prior to diagnosis compared to women without endometriosis? SUMMARY ANSWER: Women with a hospital-based diagnosis of endometriosis had an overall higher utilization of both primary and secondary h...

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Autores principales: Melgaard, Anna, Vestergaard, Claus Høstrup, Kesmodel, Ulrik Schiøler, Risør, Bettina Wulff, Forman, Axel, Zondervan, Krina, Bech, Bodil Hammer, Rytter, Dorte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546074/
https://www.ncbi.nlm.nih.gov/pubmed/37581901
http://dx.doi.org/10.1093/humrep/dead164
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author Melgaard, Anna
Vestergaard, Claus Høstrup
Kesmodel, Ulrik Schiøler
Risør, Bettina Wulff
Forman, Axel
Zondervan, Krina
Bech, Bodil Hammer
Rytter, Dorte
author_facet Melgaard, Anna
Vestergaard, Claus Høstrup
Kesmodel, Ulrik Schiøler
Risør, Bettina Wulff
Forman, Axel
Zondervan, Krina
Bech, Bodil Hammer
Rytter, Dorte
author_sort Melgaard, Anna
collection PubMed
description STUDY QUESTION: Do women with endometriosis have higher utilization of primary and secondary healthcare prior to diagnosis compared to women without endometriosis? SUMMARY ANSWER: Women with a hospital-based diagnosis of endometriosis had an overall higher utilization of both primary and secondary healthcare in all 10 years prior to diagnosis. WHAT IS KNOWN ALREADY: Endometriosis is associated with a diagnostic delay, but only a few studies have investigated the potential consequences of this delay with regard to the utilization of healthcare. To the best of our knowledge, no study has investigated it in a period corresponding to the estimated diagnostic delay. STUDY DESIGN, SIZE, DURATION: This national Danish registry-based case–control study included 129 696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: We identified 21 616 cases using density sampling. Each case was matched on age at the date of diagnosis (index date) to five women without diagnosed endometriosis (n = 108 080). The utilization of healthcare was assessed for the 10 years before the index. MAIN RESULTS AND THE ROLE OF CHANCE: Cases had significantly higher use of healthcare in all 10 years preceding the index. The mean number of yearly contacts with the GP was 9.99 for cases and 7.85 for controls, with an adjusted incidence rate ratio of 1.28 (1.27; 1.29). For hospital contacts, the association increased slightly in the first 9 years and was most profound in the last year preceding index when the adjusted incidence rate ratio was 2.26 (95% CI 2.28; 2.31). LIMITATIONS, REASONS FOR CAUTION: We were not able to include women with an endometriosis diagnosis from the general practitioner or private gynaecologist. Therefore, our results are only applicable to hospital-based diagnoses of endometriosis. We do not have information on the specific reasons for contacting the healthcare providers and we can therefore only speculate that the higher utilization of healthcare among cases was related to endometriosis. WIDER IMPLICATIONS OF THE FINDINGS: This study is in agreement with the other known studies on the subject. Future studies should include specific reasons for contacting the healthcare system and thereby identify any specific contact patterns for women with endometriosis. With this knowledge, healthcare professionals could be better at relating certain healthcare seeking behaviour to endometriosis earlier and thereby reduce the time from onset of symptoms to diagnosis. STUDY FUNDING/COMPETING INTEREST(S): This study is supported by grants from the project ‘Finding Endometriosis using Machine Learning’ (FEMaLe/101017562), which has received funding from The European Union’s Horizon 2020 research and innovation program and Helsefonden (21-B-0141). K.Z. report grants from Bayer AG, Roche Inc. and Volition, royalties from Oxford-Bayer scientific collaboration in gynaecological therapies, non-financial collaboration with the World Endometriosis Society and World Endometriosis Research Foundation and is a Wellbeing of Women research advisory committee member. All this is outside the submitted work. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: N/A.
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spelling pubmed-105460742023-10-04 Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study Melgaard, Anna Vestergaard, Claus Høstrup Kesmodel, Ulrik Schiøler Risør, Bettina Wulff Forman, Axel Zondervan, Krina Bech, Bodil Hammer Rytter, Dorte Hum Reprod Original Article STUDY QUESTION: Do women with endometriosis have higher utilization of primary and secondary healthcare prior to diagnosis compared to women without endometriosis? SUMMARY ANSWER: Women with a hospital-based diagnosis of endometriosis had an overall higher utilization of both primary and secondary healthcare in all 10 years prior to diagnosis. WHAT IS KNOWN ALREADY: Endometriosis is associated with a diagnostic delay, but only a few studies have investigated the potential consequences of this delay with regard to the utilization of healthcare. To the best of our knowledge, no study has investigated it in a period corresponding to the estimated diagnostic delay. STUDY DESIGN, SIZE, DURATION: This national Danish registry-based case–control study included 129 696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: We identified 21 616 cases using density sampling. Each case was matched on age at the date of diagnosis (index date) to five women without diagnosed endometriosis (n = 108 080). The utilization of healthcare was assessed for the 10 years before the index. MAIN RESULTS AND THE ROLE OF CHANCE: Cases had significantly higher use of healthcare in all 10 years preceding the index. The mean number of yearly contacts with the GP was 9.99 for cases and 7.85 for controls, with an adjusted incidence rate ratio of 1.28 (1.27; 1.29). For hospital contacts, the association increased slightly in the first 9 years and was most profound in the last year preceding index when the adjusted incidence rate ratio was 2.26 (95% CI 2.28; 2.31). LIMITATIONS, REASONS FOR CAUTION: We were not able to include women with an endometriosis diagnosis from the general practitioner or private gynaecologist. Therefore, our results are only applicable to hospital-based diagnoses of endometriosis. We do not have information on the specific reasons for contacting the healthcare providers and we can therefore only speculate that the higher utilization of healthcare among cases was related to endometriosis. WIDER IMPLICATIONS OF THE FINDINGS: This study is in agreement with the other known studies on the subject. Future studies should include specific reasons for contacting the healthcare system and thereby identify any specific contact patterns for women with endometriosis. With this knowledge, healthcare professionals could be better at relating certain healthcare seeking behaviour to endometriosis earlier and thereby reduce the time from onset of symptoms to diagnosis. STUDY FUNDING/COMPETING INTEREST(S): This study is supported by grants from the project ‘Finding Endometriosis using Machine Learning’ (FEMaLe/101017562), which has received funding from The European Union’s Horizon 2020 research and innovation program and Helsefonden (21-B-0141). K.Z. report grants from Bayer AG, Roche Inc. and Volition, royalties from Oxford-Bayer scientific collaboration in gynaecological therapies, non-financial collaboration with the World Endometriosis Society and World Endometriosis Research Foundation and is a Wellbeing of Women research advisory committee member. All this is outside the submitted work. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER: N/A. Oxford University Press 2023-08-15 /pmc/articles/PMC10546074/ /pubmed/37581901 http://dx.doi.org/10.1093/humrep/dead164 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Melgaard, Anna
Vestergaard, Claus Høstrup
Kesmodel, Ulrik Schiøler
Risør, Bettina Wulff
Forman, Axel
Zondervan, Krina
Bech, Bodil Hammer
Rytter, Dorte
Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study
title Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study
title_full Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study
title_fullStr Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study
title_full_unstemmed Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study
title_short Utilization of healthcare prior to endometriosis diagnosis: a Danish case–control study
title_sort utilization of healthcare prior to endometriosis diagnosis: a danish case–control study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10546074/
https://www.ncbi.nlm.nih.gov/pubmed/37581901
http://dx.doi.org/10.1093/humrep/dead164
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