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Urinary retention and catheter use among U.S. female Medicare beneficiaries: Prevalence and risk factors.

ABSTRACT: AIMS:To identify the prevalence of and risk factors for urinary retention and catheterization among female Medicare beneficiaries. METHODS:We identified women with a diagnosis of urinary retention in a 5% sample of Medicare claims in 2012. Women were categorized into three groups based on the occurrence and duration of urinary catheterization within a 1 year period: 1) no catheterization; 2) short-term catheterization (ie, one or more catheterizations in less than 30 days); and 3) chronic catheterization (catheterizations in multiple 30 day periods within 1 year). We then identified a group of age-matched controls without catheterization or a diagnosis of urinary retention in 2012. Clinical and demographic data were collected for each patient, and risk factors for retention and catheterization were compared across groups. We assessed factors associated with urinary retention using multivariable logistic regression. RESULTS:We estimated the rate of retention to be 1532 per 100?000 U.S. female Medicare beneficiaries in 2012, with rates of short term and chronic catheterization estimated to be 160 and 108 per 100?000 women, respectively. Prior diagnoses of neurologic condition, urinary tract infection, and pelvic organ prolapse were positively associated with retention and catheterization in multivariable analyses. CONCLUSIONS:We estimated the prevalence of urinary retention diagnoses among female Medicare beneficiaries to be 1532 per 100?000 women. Retention and catheterization were significantly associated with comorbid disease, with the strongest associations identified with a concomitant diagnosis of neurologic condition, UTI, and POP.

SUBMITTER: Cohn JA

PROVIDER: S-EPMC5956898 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Urinary retention and catheter use among U.S. female Medicare beneficiaries: Prevalence and risk factors.

Cohn Joshua A JA Ni Shenghua S Kaufman Melissa R MR Graves Amy J AJ Penson David F DF Dmochowski Roger R RR Reynolds W Stuart WS

Neurourology and urodynamics 20170307 8

<h4>Aims</h4>To identify the prevalence of and risk factors for urinary retention and catheterization among female Medicare beneficiaries.<h4>Methods</h4>We identified women with a diagnosis of urinary retention in a 5% sample of Medicare claims in 2012. Women were categorized into three groups based on the occurrence and duration of urinary catheterization within a 1 year period: 1) no catheterization; 2) short-term catheterization (ie, one or more catheterizations in less than 30 days); and 3) ...[more]

PMID: 28267877

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Project description:Background/objectivesTo examine the prevalence of mobility device use in U.S. community-dwelling older adults including older adults with cancer history ("survivors") and to estimate mobility disability noting variation by cancer history, cancer site, and other factors to improve early detection of mobility limitations.DesignCross-sectional analysis from the 2011 National Health and Aging Trends Study.SettingIn-person interviews in the homes of study participants.ParticipantsNationally representative sample of community-dwelling Medicare beneficiaries, aged 65 and older (n = 6,080 including 1,203 survivors).MeasurementsParticipants were asked about cancer history, pain that limited activity, mobility device use (eg, canes, walkers, wheelchairs, and scooters), history of falls, and medical conditions plus they were assessed for approximate mobility disability using a 3-m gait speed test. The results were scored on a scale of 0 to 4 (0 = lowest, 4 = highest) using criteria from the National Institute on Aging.ResultsA total of 19% of older adults and 23% of survivors reported using one or more mobility device, most commonly a single-point cane. Approximately 10% of breast, 6% of prostate, and 3% of colorectal cancer survivors reported using two or more devices in the past month. Survivors had lower mean gait speed scores (2.27) than adults without cancer history (2.39). In regression models, survivors were 18% less likely than adults without cancer history to score high on the gait speed test (odds ratio = .82; P < .05). Prior mobility device use, history of multiple falls, unhealthy weight, Black race, multimorbidity, and pain that limited activity were associated with lower gait speed scores in all participants (all P < .05).ConclusionA greater proportion of older survivors used mobility devices than adults without cancer history. Mobility device use varied by cancer site and was highest in survivors of breast, colorectal, and gynecological cancer. Survivors were also more likely to show signs of mobility disability, based on gait speed, compared with adults without cancer history. These indications, although modest, suggest that older survivors may require special attention to functional changes in survivorship.

Project description:In the last decade, many new surgical treatments have been developed to achieve less-invasive approaches to prolapse management. However, limited data exist on how the patterns of care for women with pelvic organ prolapse (POP) may have changed over the last decade, and whether mesh implantation techniques have influenced the type of specific compartment repair performed. We used a national data set to analyze the temporal trends in patterns of care for women with POP.Data were obtained from Public Use Files from the Centers for Medicare and Medicaid Services for a 5% random sample of national beneficiaries with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of POP from 1999 through 2009. Current Procedural Terminology, 4th Edition and International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes were used to evaluate nonsurgical and surgical management trends for this cohort. Types of surgery were categorized by prolapse compartment and combinations of repairs. After 2005, when applicable codes became available, mesh or graft repairs were also analyzed.Over the study time period, the number of women with a diagnosis of POP in any 1 year in our 5% sample of Medicare beneficiaries remained relatively stable (range, 21,245-23,268 per year). Rates of pessary insertion were also consistent at 11-13% over the study period. Of the women with a prolapse diagnosis, 14-15% underwent surgical repair, and there was little change over time in surgical management patterns based on compartment. Most commonly, multiple compartments were repaired simultaneously. There was a rapid increase in mesh use such that in 2009, 41% of all women who underwent surgery (5.8% of the total cohort) had mesh or graft inserted in their repair. Hysterectomy rates for prolapse decreased over time. Rates of vault suspension at the time of hysterectomy for prolapse were low; however, they showed a relative increase over time (22% in 1999 to 26% in 2009).Patterns and rates of prolapse repairs remained relatively unchanged from 1999 through 2009, with an exception of a rapid rise in mesh use. These data suggest that the majority of mesh techniques were used for augmentation purposes only, but did not result in an increase in apical repairs performed in the United States. There remains a disappointingly low rate of vault suspension repairs concomitantly at time of hysterectomy for POP.

Dataset Information

Urinary retention and catheter use among U.S. female Medicare beneficiaries: Prevalence and risk factors.

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Urinary retention and catheter use among U.S. female Medicare beneficiaries: Prevalence and risk factors.

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