{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:14:10Z","timestamp":1788891250622,"version":"build-2803163510"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020 Research and Innovation Programme and Helsefonden","award":["21-B-0141"],"award-info":[{"award-number":["21-B-0141"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>STUDY QUESTION<\/jats:title>\n                  <jats:p>How does pre-diagnosis use of hospital care differentiate between women later diagnosed with endometriosis and age-matched controls without a diagnosis?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SUMMARY ANSWER<\/jats:title>\n                  <jats:p>Women with hospital-diagnosed endometriosis had more frequent hospital contacts in the 10\u2009years leading up to the diagnosis compared to women without a diagnosis of endometriosis, and the contacts were related to registered diagnoses in nearly all of the included ICD-10 chapters for the entire period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WHAT IS KNOWN ALREADY<\/jats:title>\n                  <jats:p>Only a few studies have investigated the utilization of health care among women with endometriosis in the time before diagnosis, but current research shows that women with endometriosis have a higher utilization compared to women without diagnosed endometriosis. To our knowledge, no study has investigated the type of contact related to the higher utilization by using the ICD-10 diagnoses registered to the hospital contact.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title>\n                  <jats:p>This study was conducted as a national Danish registry-based case\u2013control study of 129\u00a0696 women. Cases were women with a first-time hospital-based diagnosis of endometriosis between 1 January 2000 and 31 December 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n                  <jats:p>Using density sampling, we identified 21\u00a0616 cases. Each case was matched on age at the date of diagnosis (index date) to five women without hospital-diagnosed endometriosis (n\u2009=\u2009108\u00a0080) at the time of matching. The utilization and registered ICD-10 diagnoses related to the hospital contact were included for the 10\u2009years before the index date.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n                  <jats:p>The probability of having a high number of hospital contacts (six or more) was more common among women with endometriosis (68.6%) compared to women without endometriosis (55.7%) In general, women without endometriosis were more likely to have fewer than six contacts. The diagnoses registered to the contact among cases were related to a greater variety of ICD-10 chapters when compared to controls with the same number of contacts. For nearly all of the included ICD-10 chapters, women with endometriosis were more likely to have a diagnosis over the entire period compared to controls, with the only exception being in the chapter related to pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n                  <jats:p>Our results are only applicable for women with hospital-based diagnosed endometriosis since we were not able to include women diagnosed at the general practitioner or private gynecologists. We were not able to make a causal interpretation, as we do not have information on the onset of symptoms of the included diseases. The association may be overestimated due to detection bias. However, a sensitivity analysis only changed the results slightly, indicating a low risk of this bias.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n                  <jats:p>This study is in accordance with previous studies on the subject, indicating that the utilization of health care prior to endometriosis is not necessarily restricted to endometriosis-related symptoms and that endometriosis can be associated with many other diseases. Future studies may explore hospital contacts and causes\/diagnoses following the endometriosis diagnosis to further shed light on whether our results are due to a pattern of multiple pathologies or rather an expression of misdiagnoses among women with endometriosis before diagnosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n                  <jats:p>This study is supported by grants from the project Finding Endometriosis using Machine Learning (FEMaLe\/101017562), which has received funding from The European Union\u2019s Horizon 2020 research and innovation program and Helsefonden (21-B-0141). A.W.H. received grant funding from NIHR, CSO, Roche Diagnostics, and Wellbeing of Women. A.W.H.\u2019s institution received consultation fees from Theramex, Joii, Gesynta, and Gedeon Richter. A.W.H.\u2019s institution received honoraria for lectures from Theramex and Gedeon Richter. A.W.H. is listed as co-inventor on a patent application (UK Patent App No. 2217921.2, International Patent App No. PCT\/GB2023\/053076). P.T.K.S.\u2019s institution (University of Edinburgh) received consultation fees from Gesynta Pharma AB and BenevolentAI Bio Ltd. P.T.K.S\u2019s institution (University of Edinburgh) declares a patent application (UK Patent Application No. 2310300.5. Androgens in diagnostic strategies for endometriosis). P.T.K.S. is a treasurer of the World Endometriosis Society, Fellowship in the Royal Society of Edinburgh, and a Scientific Advisor of the Royal College of Obstetrics and Gynaecology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>TRIAL REGISTRATION NUMBER<\/jats:title>\n                  <jats:p>N\/A.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/humrep\/deae273","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T16:01:37Z","timestamp":1734710497000},"page":"280-288","source":"Crossref","is-referenced-by-count":7,"title":["Exploring pre-diagnosis hospital contacts in women with endometriosis using ICD-10: a Danish case\u2013control study"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0209-1619","authenticated-orcid":false,"given":"Anna","family":"Melgaard","sequence":"first","affiliation":[{"name":"Research Unit of Epidemiology, Department of Public Health, Aarhus University , Aarhus C,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus H\u00f8strup","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"Research Unit for General Practice, Department of Public Health, Aarhus University , Aarhus C,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrik Schi\u00f8ler","family":"Kesmodel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Aalborg University Hospital , Aalborg,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina Wulff","family":"Ris\u00f8r","sequence":"additional","affiliation":[{"name":"Central Denmark Region, DEFACTUM , Aarhus N,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Danish Centre for Health Services Research, Aalborg University , Gistrup,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Forman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Aarhus University Hospital , Aarhus N,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krina T","family":"Zondervan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, Oxford Endometriosis CaRe Centre, University of Oxford, John Radcliffe Hospital , Oxford,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mintu","family":"Nath","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Sciences, University of Aberdeen , Aberdeen,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolapo","family":"Ayansina","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Sciences, University of Aberdeen , Aberdeen,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9051-9380","authenticated-orcid":false,"given":"Philippa T K","family":"Saunders","sequence":"additional","affiliation":[{"name":"EXPPECT Edinburgh, Centre for Reproductive Health, Institute of Regeneration and Repair, University of Edinburgh , Edinburgh,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9656-493X","authenticated-orcid":false,"given":"Andrew W","family":"Horne","sequence":"additional","affiliation":[{"name":"EXPPECT Edinburgh, Centre for Reproductive Health, Institute of Regeneration and Repair, University of Edinburgh , Edinburgh,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucky","family":"Saraswat","sequence":"additional","affiliation":[{"name":"University of Aberdeen , Aberdeen,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorte","family":"Rytter","sequence":"additional","affiliation":[{"name":"Research Unit of Epidemiology, Department of Public Health, Aarhus University , Aarhus C,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"2025020305512049200_deae273-B1","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1111\/j.1471-0528.2008.01878.x","article-title":"Can symptomatology help in the diagnosis of endometriosis? 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