High Age Predicts Low Referral of Hyperthyroid Patients to Specialized Hospital Departments: Evidence for Referral Bias

Allan Carlé, Inge Bülow Pedersen, Hans Perrild, Lars Ovesen, Torben Jørgensen, Peter Laurberg

Research output: Contribution to journalJournal articleResearchpeer-review

17 Citations (Scopus)

Abstract

Background: Hospital-based studies may be hampered by referral bias. We investigated how the phenomenon may influence studies of hyperthyroid patients. Methods: By means of a computer-based linkage to the laboratory database and subsequent detailed evaluation of subjects with abnormal test results, we prospectively identified all 1,148 patients diagnosed with overt hyperthyroidism in a four-year period in and around Aalborg City, Denmark. Each patient was classified according to nosological type of hyperthyroidism. We studied the referral pattern of patients to local hospital units, and analyzed how referral depended on subtype of disease, sex, age, and degree of biochemical hyperthyroidism. Results: In a 4-year period, 1,032 hyperthyroid patients were diagnosed at primary care offices, and 435 of these (42.2%) were referred to specialized units, 92 patients had hyperthyroidism diagnosed in other hospital departments (referral: 43, 46.7%), and 24 patients had hyperthyroidism diagnosed at the specialized unit after referral for other diseases. Patients suffering from Graves' disease (GD; n=474, median age=65.8 years) were referred more often (odds ratio=1.7 [95% confidence interval 1.3-2.2]) than those diagnosed with multinodular toxic goiter (MNTG; n=525, median age=74.6 years). Higher age was associated with less referral of patients suffering from MNTG (referred vs. nonreferred patients, 64.0 vs. 77.4 years, p
Original languageEnglish
JournalThyroid
Volume23
Issue number12
Pages (from-to)1518-1524
ISSN1050-7256
DOIs
Publication statusPublished - 2013

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