title: Patterns of hematuria referral to urologists: does a gender disparity exist?
abstract: OBJECTIVE
  To examine the referral patterns of hematuria within a nonprofit healthcare organization to determine the factors that influence referral. Hematuria continues to be an important sign of urologic disease, including urothelial malignancy. An increasing awareness of gender differences in tumor stage at bladder cancer presentation has led to speculation about delayed referral and diagnosis in women. However, little is known about the referral patterns of hematuria and whether gender differences exist.
  
  
  METHODS
  The insurance records were examined from 926 consecutive adult health plan participants (559 men and 367 women) with newly diagnosed hematuria from 1998 to 2002. The patterns of urologic referral were evaluated. A Cox multivariate regression model was used to examine the relationship between urologic referral and the relevant variables.
  
  
  RESULTS
  Overall, 263 men (47%) and 102 women (28%) were referred for urologic evaluation of hematuria, with a median follow-up of 27 and 26 months, respectively. Referral was initiated by the primary care physician in 80% of the cohort. Increased urologic referral was associated with advancing age, repeated hematuria, provider type, and male gender. The adjusted hazard ratio of male referral was 1.65 (95% confidence interval 1.31-2.08) compared with female referral.
  
  
  CONCLUSIONS
  Primary care physicians practicing in a managed care setting are less likely to refer women for a urologic evaluation of new or first recurrent episodes of hematuria than to refer men in all patient age categories, except for 40-49 years. This apparent gender disparity could result in unequal access of specialty evaluation and could potentially delay the diagnosis of important urologic conditions.
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA.
authors.forename: Emilie K
authors.initials: EK
authors.lastname: Johnson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Daignault
authors.forename: Yingxi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D014572:Urology / Q000379:methods*