Urologic Disease Burden in the United States: Veteran Users of Department of Veterans Affairs Healthcare

Objectives

To determine the disease burden, measured by resource utilization, of four urologic conditions among veteran users of U.S. Department of Veterans Affairs (VA) healthcare services and to assess variations by selected sociodemographic characteristics.

Methods

We applied expert-derived diagnosis clusters to establish four patient cohorts from a population of U.S. veterans aged 18 years and older with at least one outpatient visit in a VA healthcare facility in fiscal year 2001 (n = 3,691,519): (1) benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS), (2) kidney stones (KS), (3) urinary tract infections (UTI), and (4) urinary incontinence (UI). We identified patients with qualifying diagnosis codes associated with outpatient visits in the national VA Outpatient Clinic file, thereby generating case counts for each diagnostic category.

Results

Among veteran users of VA healthcare services, when defined as the primary reason for the visit, the prevalence of BPH/LUTS was 4811 per 100,000 veterans (4.8%); the prevalence of KS was 597 per 100,000 (0.6%); the prevalence of UTI was 4265 and 1719 per 100,000 female and male veterans, respectively (4.3% and 1.7%); and the prevalence of UI was 2161 and 515 per 100,000 female and male veterans, respectively (2.2% and 0.5%). Prevalence of these conditions when ascertained by capturing diagnoses appearing as secondary reasons for a physician visit was much higher.

Conclusions

Although we expected the prevalence of urologic conditions to be high among veterans who use the VA system for care, we found the burden of urologic disease among veterans to be comparable to other national data sets. Prevalence estimates based on primary diagnosis, rather than secondary or “any” diagnosis, significantly underestimated the disease burden among veterans.