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Office Visits for Male Genitourinary Conditions: National Ambulatory Medical Care Survey: United States, 1977-78’

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Office Visits for Male Genitourinary Conditions: National Ambulatory Medical Care Survey: United States, 1977-78’ PROPERTY OFTHE . PUBLICATIONS BRANCH EDITORIAL LIBRARY — FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEAL 7H STATISTICS U.S. DEPARTMENT OF HEALTH . public Healthservice Number 63 � November 3, 1980 AND HUMAN SERVICES Office of Health Research, Statistics, and Technology Office Visits for Male Genitourinary Conditions: National Ambulatory Medical Care Survey: United States, 1977-78’ This report combines estimates from the (ICDA-8).2 Genitourinary visits are divided 1977 and 1978 National Ambulatory MedicaI into two subgroups : a urs”nary visit, which is Care Surveys to describe office visits made by defined as a visit for which the principal men who, over the 2-year period, sought treat­ diagnosis was a disease of the urinary system ment for problems of the genitourinary system. (ICDA subgroup 580-599), and a genital visit, Conducted annually by the National Center for which is defined as a visit for which the principal Health Statistics, the National Ambulatory diagnosis was one of the conditions listed in the Medical Care Survey (NAMCS) is a sample ICDA code range 600-629. urvey designed to explore the provision and tilization of ambulatory care in the offices of @ non-Federal, office-based physicians. (See the DATA HIGHLIGHTS “Technical Notes” at the e;d- of this r~port for information on the survey design and terminol­ Over the 2-year span 1977-78, the male visit ogy.) Because the statistics used in this report rate for genitourinary problems was estimated at are based on a sample rather than on the entire 76 office visits per year for every 1,000 men in universe of office-based physicians, they are the population. As shown in tables 1 and 2, estimates only and are subject to sampling supplemented by figures 1 and 2, the genito­ variability. Guidelines for judging the precision urinary visit rate for men was modest compared of the estimates may be found in the “Technical with the corresponding visit rate for women. At Notes.” A premonitory note: any visit estimate an estimated 254 office visits per year per 1,000 that is under 340,000, or its percentage equiva­ women in the population, the female visit rate lent, is preceded by an asterisk, signifying that it was over three times as great as the rate for exceeds a relative standard error of 30 percent. males, chiefly due to the dramatic difference A genitourinary visit is an office visit for between the sexes in the visit rates for genital which the principal dia~osis was a condition disorders. For genital problems, which unlike classified in the major diagnostic group urinary problems, are sex-specific, the visit rate “Diseases of the Genitourinary System” (diag­ for women was 176 visits per year per 1,000 as nostic codes 580-629), according to the Eighth opposed to 46 visits per year per 1,000 for men. Revision International Classification of Diseases, Adapted for Use in the United States 2National Center for Health Statistics: Eighth Re- vision International Classification of Diseases, Adapted for Use in the United States. PHS Pub. No. 1693. Public lThis report was prepared by Hugo Koch, Division Health Service. Washington. U.S. Government Printing �of Health Resources Utilization Statistics. Office, 1967. 2 acklncedata — The male genitourinary visit rate increased The majority (52 percent ) of all male genito directly and steeply with advancing age (table 2 urinary visits were made to an office-based _ and figure 2). Male patients 65 years of age and urologist (table 5). Men were especially prone to over made 8 times as many urinary visits and 11 visit this specialist when they suffered from a times as many genital visits as those under 25 genital ailment. It would be shortsighted, how- years of age did. ever, to underestimate the role played by the Visits made for genital ailments by men primary-care physician. Table 5 shows that outnumbered visits made for urinary problems nearly one-half of the visits by men for urinary in a ratio of about 3 to 2. Note in table 3 that ailments were made to physicians in the the prostate is the organ requiring the most primary-care specialties of general and family office treatment. The conditions of hyperplasia practice and internal medicine. and prostatitis together account for 40 percent When the male genitourinary ailment was a, of all male genitourinary visits. new condition (in about 1 of every 3 visits), it In a 1978 study of the national prevalence resulted in roughly 2 return visits during the of urinary disease, women showed a higher rate course of a year (table 6). This finding is for almost all urinary ailments than men did compatible with the earlier statistic derived from (36.4 urinary conditions per 1,000 women as prevalence data. Referral of male patients was opposed to 14.6 urinary conditions per 1,000 more than twice as common for genital disorders men). Only with calculus of the kidney and than it was for urinary disorders. The direction , ureter was the prevalence among men (4. 7 per of this patient flow (from primary-care physi­ 1,000) higher than among women (3.4 per cian to urologist) underscores the prominence of 1,000 ).3 The NAMCS findings in table 4 show this secondary-care provider in the treatment of the impact of prevalence on one treatment male genital disease. setting—the doctor’s office. These findings sug­ The NAMCS makes it possible to identify gest an average of about 2 office visits per year the patient’s symptoms that are associated with for every person who suffered from a urinary the doctor’s diagnosis. For male genitourinary disease and faithfully reflect the female-male visits, the leading 10 presenting symptoms in� differences found in the prevalence study. order of frequency were: , 3UnpUblished findings from the Health Interview 1. Frequency and urgency of urination. Survey, 1978, a household survey conducted yearly by the National Center for Health Statistics. 2. Painful urination. Table 1. Number of all office visits and of genitourinary visits and visit rate per year per 1,000 members of the civilian noninstitutional ized population, by sex of patient and principal diagnostic condition: United States, 1977-78 Both sexes Male Female Principal diagnostic condition and Number Number of Number Number of Number Number of I CDA codes 1 of visits visits per of visits visits per of visits visits per in year per 1,000 in year per 1,000 in year per 1,000 thousands population thousands population thousands population All conditions, all visits .. .. ... .. 1,154,550 2,727 460,119 2,252 694,431 3,170 Diseases of the genito- urinary system .. .... ... ...580-628 71,224 168 15,593 76 55,630 254 Diseases of the urinary systam .. .. .. .. ... .... .. ... .. .. .. ... ....58O-599 23,867 56 6,141 30 17,725 81 Diseases of the genital system .... ..... .. .. .... ... .... .. .. .... ...6 OO-629 47,357 112 29,452 46 37,905 173 ‘Based on Eighth Revision International C’lassr”fication of Diseases, Adapted for Uee in the United States (lCDA-8). z~nclude~ *3 I 2,000 visits for breast d@-. I — ackme&a3 3. Other urinary dysfunctions (e.g., reten­ Figure 1. PERCENT DISTRIBUTION OF ALL GENITOURINARY tion, hesitancy, large voIume). VISITS,l BY SEX OF PATlENT AND GENITOURINARY SUB- GROUP: UNITED STATES, 1977-78 4. Symptoms of the scrotum and testes (e.g., pain, swelling, inflammation, growths, itching). %x%%:\ ~ Femaleurinarv disease 5. Prostate symptoms (e.g., swelling, infec­ tion). 6. Abnormalities of urine (e.g., presence of blood or pus, unusual coIor or odor). 7. PeniIe discharge. 8. Back symptoms. 9. Penis symptoms (e.g., pain, inflamma­ tion, swelling, growths). 10.Pain, site not referable to a specific body system (e.g., side or groin pz&). Table 7 explores the diagnostic procedures that were brought to bear on the presenting symptoms of male genitourinary disease. Pre­ dictably, the key dia~ostic tool (applied in 2 of every 3 visits) was the laboratory test. A general Figure 2 NUMBER OF URINARY AND GENITAL VISITS PER xamination was the exception, as it is through- YEAR PER l,ODO MEMBERS OF THE CIVILIAN NONINSTITU­ TIONALIZED POPULATION, BY SEX OF PATl ENT: UNITED @ out aIl male ambulatory care. The frequency of STATES, 1977-78 blood pressure checks during male genitourinary visits (22 percent) is primarily due to their ------ Male urinarf visirs :.\. /\ — Male genitalvisits i “-, i ‘N -——Femaleurinmy visits Table 2. Number of urinary and genital visits and visit rate per ‘\, i year per 1,000 members of the civilian noninstitutionalized \. --—- Femalegmiral visits population, by sax and age of patient: Unitad States, i \ 1977-78 i ; i ;, i \ i ii i \ i i i i, i \ Number in thousands i i i I ..- All ages...... 6,141 I 17,725 [ 29,140 I 37S05 i ---- /- ..- // I Number per year per 1,000 population ,/ Total ... ....... 30 81 45 173 /“ ,/ Under 25 years ........... 12 49 12 106 2544 years ................ 27 90 42 275 45-64 years ................ 46 108 79 239 65 years and over .... ... 92 122 134 72 o- 65 and 1Bawd on Eighth R~ision International Ck7ssmation of 25 over Diseases,Adapted for Use in the United States (lCDA-8). AGE OF PATlENT IN YEARS � 2Exclude~ *312,000 visits fOr breast di~ase. I 4 admcecw Table 3. Number and percent distribution of male geni~ourinary visits and visit rate per year per 1,000 male members of the civilianc noninstitutionalized population, by principal diagnostic condition associated with visit: United States, 1977-78 i Male genitourinary visits Principal diagnostic condition associated with male genitourinary visit and Number Number per year ICDA codesl Percent in per 1,000 distribution thousands male population All male genitourinary diseasas ..
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