Referral Bias in Defining the Phenotype and Prevalence of Obesity in Polycystic Ovary Syndrome
Referral Bias in Defining the Phenotype and Prevalence of Obesity in Polycystic Ovary Syndrome
复制标题
DOI：
10.1210/jc.2013-1295
复制
发表时间：
2013-06-01
影响因子：
5.8
通讯作者：
Azziz, Ricardo
中科院分区：
文献类型：
--
作者：
Ezeh, Uche;Yildiz, Bulent O.;Azziz, Ricardo
背景：所描述的多囊卵巢综合征（PCOS）表型主要基于参考（自身或其他）人群的发现。如果在其自然（无偏）状态下检测和研究PCOS，则PCOS的表型可能会有所不同。目的：我们的目的是比较在未选择人群中检测到的PCOS表型与在转诊人群中发现的PCOS表型。参与者：参与者包括292名多囊卵巢综合征患者（转诊多囊卵巢综合征）和64名多囊卵巢综合征妇女（未选择的多囊卵巢综合征），这些多囊卵巢综合征患者是通过668名寻求就业前体检的人群筛选确定的。在接受就业前体检的女性中，563人没有表现出这种疾病的特征（未选择的对照组）。所有多囊卵巢综合征的受试者都符合美国国立卫生研究院1990年对该疾病的标准。主要结局指标：我们估计了肥胖的患病率和疾病负担的严重程度。结果：转诊PCOS患者的平均体重指数和多毛症评分更高，高雄激素血症程度更高，非西班牙裔白人（83.90%）的可能性更大，PCOS亚表型比未选择的PCOS或未选择的对照组更严重。转诊多囊卵巢综合征患者的肥胖和严重肥胖患病率分别是未选择多囊卵巢综合征患者的2.3倍和2.5倍，是非选择对照组的2.2倍和3.8倍。另外，未选择的多囊卵巢综合征受试者有肥胖和严重肥胖的患病率，平均体重指数与他们得出的一般人群相似。结论：多囊卵巢综合征（PCOS）的表型，包括种族/民族混合、表现严重程度和肥胖率，受多囊卵巢综合征患者是来自转诊人群还是通过非选择性筛查的显著影响，可能反映了患者关注和意识的程度以及获得医疗保健的程度。
Background: The described phenotype of the polycystic ovary syndrome (PCOS) has been primarily based on findings in a referred (self or otherwise) population. It is possible that the phenotype of PCOS would be different if the disorder were to be detected and studied in its natural (unbiased) state.Objective: Our objective was to compare the phenotype of PCOS detected in an unselected population with that identified in a referral population.Participants: Participants included 292 PCOS patients identified at a tertiary care outpatient facility (referral PCOS) and 64 PCOS women (unselected PCOS) identified through the screening of a population of 668 seeking a pre-employment physical. Among the women undergoing a pre-employment physical, 563 did not demonstrate features of the disorder (unselected controls). All PCOS subjects met the National Institutes of Health 1990 criteria for the disorder.Main Outcome Measures: We estimated prevalence of obesity and severity of disease burden.Results: Referral PCOS subjects had greater mean body mass index and hirsutism score and higher degrees of hyperandrogenemia, were more likely to be non-Hispanic White (83.90%), and demonstrated a more severe PCOS subphenotype than unselected PCOS or unselected controls. The prevalence of obesity and severe obesity in referral PCOS was 2.3 and 2.5 times greater than estimates of the same in unselected PCOS and 2.2 and 3.8 times greater than estimates in unselected controls, respectively. Alternatively, unselected PCOS subjects had a prevalence of obesity and severe obesity and a mean body mass index similar to those of the general population from which they were derived.Conclusion: The phenotype of PCOS, including the racial/ethnic mix, severity of presentation, and rate of obesity, is affected significantly by whether the PCOS subject arises from a referral population or through unselected screening, likely reflecting the degree of patient concern and awareness and access to healthcare.