Why Is Vaginal Estrogen Still Underused? - Summary - MDSpire
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Why Is Vaginal Estrogen Still Underused?
A large Epic Cosmos analysis linked vaginal estrogen prescribing with lower rates of sepsis, hospital admission, and death following recurrent urinary tract infection, but researchers cautioned that prescribing may also mark broader differences in care.
To analyze the association between vaginal estrogen prescribing and rates of sepsis, hospital admission, and all-cause mortality in female patients with recurrent urinary tract infections.
Approach:
Study Design: An observational, unadjusted database analysis using the Epic Cosmos database, which includes over 1.9 million female patients diagnosed with recurrent urinary tract infections.
Patient Classification: Patients were classified as vaginal estrogen recipients if they had a prescription within 2 months of their second urinary tract infection.
Outcome Measures: Outcomes included rates of sepsis, hospital admission, and all-cause mortality within 8 years.
Key Findings:
5.1% of patients received vaginal estrogen prescriptions within 2 months of diagnosis.
Unadjusted rates of sepsis were lower in recipients (4.2% to 10.4%) compared to nonrecipients (8.5% to 24.1%).
Hospital admission rates were lower in recipients (7.5% to 12.0%) compared to nonrecipients (15.7% to 27.5%).
All-cause mortality rates were lower in recipients (0.3% to 3.9%) compared to nonrecipients (0.8% to 9.6%).
Interpretation:
The study emphasizes that the observational nature and lack of multivariable adjustment limit causal inferences regarding the association between vaginal estrogen prescribing and adverse outcomes.
Limitations:
All reported odds ratios were unadjusted due to the observational nature of the study.
The study could not confirm whether prescriptions were filled or used consistently.
Mortality data may be underestimated due to reliance on discharge disposition codes.
The findings may not generalize to under-resourced settings.
Conclusion:
The analysis indicates an association between vaginal estrogen use and improved outcomes in recurrent urinary tract infections, highlighting the need for further research to understand the underutilization of this therapy.
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