Demographic Differences and Disparities in the Misdiagnosis of Interstitial Cystitis/Bladder Pain Syndrome in a National Cohort of VA Patients.

To explore association between misdiagnosis of IC/BPS and demographics. Interstitial cystitis/bladder pain syndrome (IC/BPS) is associated with significant diagnostic uncertainty, resulting in frequent misdiagnosis as there is little known about the potential impact of key demographic factors.

All patients in the VA system between 1999-2016 were identified by ICD-9/10 codes for IC/BPS (595.1/N30.10) (n=9,503). ICD code accuracy for true IC/BPS (by strict criteria) was assessed by in-depth chart abstraction (n= 2,400). Associations were explored between rates of misdiagnosis and demographics.

IC/BPS criteria were met in only 651 (48.8%) of the 1,334 charts with an ICD code for IC/BPS reviewed in depth. There were no differences in the misdiagnosis rate by race (p=0.27) or by ethnicity (p=0.97), after adjusting for differences in age and gender. In IC/BPS-confirmed cases, female patients were diagnosed at a younger age than males (41.9 vs. 58.2 years, p<0.001). Black and Hispanic patients were diagnosed at a younger age compared to White (41.9 vs. 50.2 years, p<0.001) and non-Hispanic patients, respectively (41.1 vs. 49.1 years, p=0.002).

There was a high rate of misdiagnosis of IC/BPS overall, with only 48.8% of patients with an ICD code for IC/BPS meeting diagnostic criteria. There were no significant associations between diagnostic accuracy and race/ethnicity. Black and Hispanic patients were more likely to receive a diagnosis of IC/BPS at a younger age, suggesting there may be differing natural histories or presentation patterns of IC/BPS between racial/ethnic groups.

Urology. 2021 Aug 01 [Epub ahead of print]

Kai B Dallas, Catherine Bresee, Amanda De Hoedt, Justin F Senechal, Kamil E Barbour, Jayoung Kim, Stephen J Freedland, Jennifer T Anger

Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: ., Department of Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA., Veterans Affairs Medical Centers, Urology Section, Durham, NC., National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA., Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, California.

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