title: Medical attendance for lower urinary tract symptoms is associated with subsequent increased risk of outpatient visits and hospitalizations based on a nationwide population-based database.
abstract: BACKGROUND
  Lower urinary tract symptoms (LUTS), which encompass storage, voiding, and postmicturition symptoms, are highly prevalent and recognized globally. Based on a nationwide population-based database, this study tests the hypothesis that medical attendance for LUTS is associated with a subsequent increase in the number of outpatient visits and hospitalizations, with differences among medical specialties and age groups.
  
  
  METHODS
  Participants were selected from a random population sample of approximately one million people as a representative cohort of National Health Insurance (NHI) enrollees in Taiwan. Participants had at least three outpatient service claims with a coding of LUTS during the recruitment period 2001-2004. Both the LUTS group and non-LUTS control group were monitored for subsequent outpatient visits and hospitalizations, excluding LUTS-related healthcare services, for 2 years following the index date. The results were categorized based on medical specialty and age group.
  
  
  RESULTS
  The outpatient visit rates (no. per person-year) and adjusted incidence rate ratios (IRRs) (95% confidence interval (CI) were significantly higher in urology (4.51, 95%CI 4.15-4.91) and gynecology (1.82, 95%CI 1.76-1.89) for the LUTS group. They were also significantly high in other departments, including internal medicine (1.25), general practice (1.13), Chinese medicine (1.77), family medicine (1.19), surgery (1.38), and psychiatry (1.98). Similarly, the hospitalization rate (no. per 1000 person-year) and adjusted IRRs (95% CI) were significantly higher in urology (5.50, 95% CI = 4.60-6.50) and gynecology (1.60, 95% CI = 1.35-1.90), as well as in internal medicine (1.55) and surgery (1.56), but not in psychiatry (1.12). Furthermore, the IRRs differed among 3 age groups.
  
  
  CONCLUSIONS
  A significantly higher number of outpatient visits and hospitalizations were observed for individuals with LUTS, compared to the control group, and the effects differed with the advancement of age. This study broadens understanding of LUTS by viewing their impact on healthcare services with multiple and overlapping systems, rather than considering them exclusively as symptoms of traditional diseases of the bladder and urethra.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan Authority.
authors.forename: Ming-Ping
authors.initials: MP
authors.lastname: Wu
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Hsu
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010045:Outpatients; D015995:Prevalence; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D014522:Urethral Diseases / Q000453:epidemiology / Q000628:therapy; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000628:therapy