Severity of the Endocrine Condition at First Referral is Associated with Gender, Ethnicity and Socio-economic Status but not with the Location of Clinic

Background The Endocrine Institute at Schneider Children's Medical Center of Israel has two branches of "Schneider in the Community". Physicians servicing both locations hypothesized that patients referred to "Schneider in the community" were of lower socio-economic status (SES) and presented with a more severe condition.
Objective To assess the severity of the endocrine condition at time of first referral in association with the type of clinic
(hospital-based vs. community-based), gender and SES.
Study design Retrospective chart review of 4528 new referrals to endocrine clinics during 2011-2012. Included in the study were 1468 patients referred for growth and weight disorders. The cohort was divided into groups according to clinic type. Parameters of severity were height SDS and BMI SDS.
Results In our study cohort growth disorders represented 79.6% of referrals (94.7% suspected short stature); 45.9% were defined as having a true endocrine condition. Severity at presentation was similar between hospital-based and community-based clinics; hospital-based clinic comprised more Arab patients (10.2% vs. 2.0%, P<0.01) and patients with higher SES ranking (11.6±4.5 vs. 10.7±3.3, P<0.01). Girls had lower Ht-SDS (-1.83±0.70 vs. -1.72±0.69, P<0.05), and boys had higher BMI-SDS (2.28±0.81 vs. 2.09±0.61, P<0.05). A significant correlation was found between lower SES and more severe short stature and overweight (R=0.20 and R=-0.20 respectively, P<0.001).
Conclusions Primary care physicians refer patients for endocrine consultation with a similar degree of severity to hospital-based and community-based clinics. Our findings suggest gender and SES as important factors affecting referrals and therefore severity at presentation.