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Commentary on diagnosis and treatment patterns of Peyronie’s disease among different racial, ethnic, and regional groups in the Veterans Affairs health care system

International Journal of Impotence Research volume 35, pages 764–765 (2023)Cite this article

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Access to quality healthcare is an important topic that has, thankfully, gained significant traction in the peer-reviewed research space over the last decade or so. However, very little work has been carried out within our field of sexual medicine to evaluate the impact of race and ethnicity on patient evaluation and treatment-related outcomes. In their manuscript from this month’s edition of International Journal of Impotence Research, Nackeeran et al sought to characterize differences in diagnosis and treatment patterns for Peyronie’s Disease (PD) based on race/ethnicity and geographic location for patients treated at the United States (US) Veterans Affairs (VA) Health Care system [1]. The VA is the largest integrative healthcare system in the US, with complete coverage for general primary healthcare and specialty care for veterans of the US armed forces who meet specified criteria [2]. The VA system includes over 1,000 healthcare facilities and over 170 medical centers. Needless to say, this is a large and complex healthcare organization, and given that the VA uses a large integrated medical record, there is some real potential to glean important information about healthcare access and deliver. In their manuscript, Nackeeran et al hypothesized that more equitable care access, particularly when compared to other systems that rely on alternative forms of healthcare coverage, would impact diagnosis and treatment related outcomes based on racial/ethnic and regional factors [1].

The authors identified more than 5.5 million male veterans who accessed care through the VA network over the timeframe of their analysis, including 17,600 who had a diagnosis of PD. 70%, 15%, and 6% of patients were white, Black, and Hispanic, respectively. The PD prevalence rate for the entire group was 0.3%, which was lower than anticipated when comparing results from other studies using similar methodologies [3,4,5]. Reasons for these differences are likely multi-factorial, but may include the absence of specific diagnostic codes associated with a patient record when he is not planning for subspeciality evaluation and treatment (i.e. the diagnosis was never recorded because there was no further evaluation planned). Another hypothesis is that, for a variety of reasons, patients seeking care at the VA are less likely to report their PD symptoms to their evaluating physicians. Interestingly, patients with PD in Nackeeran et al’s study had higher rates of other medical comorbidities including various cardiovascular risk factors.1re This suggests that PD may be associated with these other health problems, or alternatively that patients receiving care for these problems are more likely to report their symptoms and ultimately seek care for the PD. Finally, patients who receive care at the VA may also see experts externally, particularly if there are not subspecialty physicians available in their region. These patients may not be adequately captured in the VA medical record, particularly if their treatment was administered externally.

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References

  1. Nackeeran S, Zucker I, Efimenko I, Weber A, Brown SC, Ramasamy R, et al. Diagnosis and treatment patterns of Peyronie’s disease among different racial, ethnic, and regional groups in the Veterans Affairs healthcare system. Int J Impot Res. 2022. https://doi.org/10.1038/s41443-022-00615-y

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  1. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Matthew Ziegelmann

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Correspondence to Matthew Ziegelmann.

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Ziegelmann, M. Commentary on diagnosis and treatment patterns of Peyronie’s disease among different racial, ethnic, and regional groups in the Veterans Affairs health care system. Int J Impot Res 35, 764–765 (2023). https://doi.org/10.1038/s41443-023-00683-8

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