Pre-Diagnosis Hospital Utilization Patterns in Women With Endometriosis

Frequent Hospital Contacts for Diverse Causes Noted Before Endometriosis Diagnosis

Key Points

Importance:

• Endometriosis symptoms may contribute to diverse hospital contacts before diagnosis.
• Misdiagnoses or multiple pathologies could explain the healthcare utilization patterns.

Highlights:

• Women with endometriosis had more frequent and varied hospital visits in the 10 years before diagnosis compared to those without the condition.

What's done here: 

• The Danish registry-based case-control study investigated the number of hospital admissions before diagnosis in women with endometriosis compared to those without the condition.
• Approximately 130,000 women with a first-time hospital-based diagnosis of endometriosis were included in the study, covering the period from 2000 to 2017.
• The researchers used Civil Personal Registration numbers to track hospital admissions, including visits to both public and private hospitals, starting from 1995.
• Each case was matched 1:5 with controls, and ICD-10 codes were used to compare hospital admission numbers.

Key Results: 

• Women iparticipated in the study were diagnosed with endometriosis either through imaging (42%) or histologically confirmed methods (58%).
• After excluding cases that did not meet the inclusion criteria, the final sample included 21,616 women with endometriosis and 108,080 matched controls.
• Women with endometriosis had more frequent hospital visits (68.6% had six or more contacts vs. 55.7% in controls).
• Diagnoses spanned most ICD-10 chapters, except pregnancy-related conditions.

Limitations of the Study:

• Focused only on hospital-diagnosed cases; general practitioner and private gynecologist data are not included.
• Study could not establish causation or symptom onset timing.

Lay Summary

Endometriosis is commonly associated with symptoms such as painful periods, chronic pelvic pain, and infertility. Diagnosing the condition is challenging due to symptom overlap with other gynecologic and gastrointestinal disorders, as well as the need for advanced imaging or laparoscopic techniques. Many women report a prolonged diagnostic process involving repeated visits to multiple clinics. Although previous studies have shown that women with endometriosis utilize healthcare services more frequently, little is known about their hospital contacts prior to diagnosis.

To address this, Melgaard et al. from Aarhus University conducted a national case-control study using the Danish National Patient Registry, which includes data on all public hospital admissions and diagnoses. The study examined hospital admissions up to 10 years before an endometriosis diagnosis, focusing on ICD-10 codes. Patients were categorized into two groups: those diagnosed with endometriosis during their first hospital visit (Category A) and those whose initial hospital visits were for other conditions but were later diagnosed with endometriosis (Category B). Hospital contacts were classified into two groups: 1–6 contacts and more than six contacts.

It was determined that the ICD-10 codes of those who were admitted to the hospital many times before being diagnosed with endometriosis were generally related to gastrointestinal and urinary disorders and infertility.

The authors concluded that all those numerous hospital contacts before the actual diagnosis of endometriosis depend on the comorbidities related to endometriosis and misdiagnosis due to the symptomatology related to urinary and gastrointestinal disorders. This study was recently published in Human Reproduction.

Research Source: https://pubmed.ncbi.nlm.nih.gov/39704775/