TOPLINE:
Emergency department (ED) visits, hospital admissions, and wait times to see a urologist for urologic conditions increased significantly in Ontario, Canada, from 2007 to 2022, a study found. Older age, greater comorbidity, and low income were associated with a higher risk for admission and longer wait times, whereas greater continuity of care reduced admissions.
METHODOLOGY:
- Researchers conducted a population-based retrospective cohort study using health administrative data from all EDs and acute care hospitals in Ontario, Canada, and included 2,192,213 unique ED visits of adults (mean age, 52.1 years; 66.5% women) with a primary urologic diagnosis between 2007 and 2022.
- Patients were identified as having new urologic diagnoses if they had no prior ED or specialist visits in the preceding 2 years. Analyses were stratified by age, sex, comorbidity, income, rurality, and continuity of care.
- Comorbidity was assessed using the Charlson Comorbidity Index score over the past 24 months. Continuity of care was assessed using the Bice-Boxerman Continuity of Care Index over the past 12 months.
- The primary outcome was a hospital admission following an ED visit. Secondary outcomes were index ED visits for a primary urologic diagnosis and wait times to see a urologist in the outpatient setting.
TAKEAWAY:
- Overall, 10.0% of ED visits resulted in hospital admission, with urinary tract infection being the most common diagnosis (51.9%). Admission rates increased from 0.07 to 0.09 per 100 people (rate ratio [RR], 1.04; P < .001) between 2007 and 2022. ED visit rates increased from 0.91 to 1.0 per 100 people (RR, 1.10) between 2007 and 2015; they declined by 2020 (RR, 0.88) and increased again by 2022 (RR, 0.91). Women had higher ED visit rates than men (1.22 vs 0.65 per 100 people).
- A total of 14.1% of ED visits resulted in outpatient urology visits, with the percentage of such ED visits increasing from 10.97% in 2007 to 15.30% in 2022 (RR, 1.03; P < .001). The overall mean wait time was 78.3 days. Mean wait time increased from 62.5 days in 2007 to 84.8 days in 2014 and then decreased to 71.1 days in 2022.
- The likelihood of hospital admission increased with each year of age (odds ratio [OR], 1.06). Women had lower odds of admission than men (OR, 0.68). Individuals with greater continuity of care had a lower likelihood of admission (OR, 0.83) and an earlier follow-up visit (hazard ratio [HR], 1.15).
- Women experienced longer wait times to see a urologist than men (HR, 0.28). Patients in the lowest income quintile had longer waits than those in the highest quintile (HR, 0.88), and those with greater comorbidity had an increased risk for longer wait times than those without comorbidities (HR, 0.57).
IN PRACTICE:
“The annual ED visit rates for new urologic diagnoses, hospital admissions, and wait times to see urologists significantly increased over the study period. These trends were associated with decreasing continuity of care,” the authors wrote.
“This work emphasizes the importance of enhancing primary care access and continuity to mitigate hospitalizations and reduce wait times for people with urologic conditions,” they added.
SOURCE:
The study was led by Rano Matta, MD, MSc, University of Toronto, Department of Surgery, Toronto, Ontario, Canada. It was published online on March 09, 2026, in JAMA Network Open.
LIMITATIONS:
The study included data from Ontario only, possibly limiting the generalizability of the findings to other regions in Canada or countries with publicly funded health systems. It also did not account for frequent ED users, who account for about 5% of patients but approximately 25% of visits, introducing potential bias.
DISCLOSURES:
The study was funded by the Ajmera Family Chair in Urologic Oncology at the University of Toronto. The authors reported having no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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