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Demographic and Socioeconomic Factors Associated with Urinary Stone Disease Management in a Large Urban US Population.

S. Patel,C. Futral,C. Miller,R. Bose,James T. Kearns,P. Clark,Ornob P Roy

Published 2021 in Urology

ABSTRACT

OBJECTIVE To determine the influence of socioeconomic parameters on urinary stone surgeries. METHODS A retrospective cohort study analyzed patients undergoing urolithiasis surgery in our community network hospital in North Carolina from 2005-2018. RESULTS Of 7,731 patients, 2,160 (28%), 5,174 (67%), and 397 (5%) underwent SWL, URS, and PCNL, respectively. A higher proportion of Whites underwent URS (67%) and SWL (74%) than PCNL (56%); whereas a larger percentage of Blacks underwent PCNL (24%) than URS (20%) and SWL (15%) groups (P < 0.001). Private insurance payers were greater in the SWL (95%) group than URS (80%) and PCNL (81%) (P<0.001). The distribution of median income was significantly different amongst the three surgeries with higher income classes overutilizing SWL and underutilizing PCNL compared to lower income classes (P<0.001). In linear regression modeling, the proportion of SWL in a postal code was positively associated with median income (R2=0.55, P<0.001); URS and PCNL were negatively associated with median income (R2=0.40, P<0.001 and R2=0.41, P<0.001, respectively). On multivariate logistic regression modeling, Blacks were significantly more likely to undergo PCNL than Whites (aOR 1.32, 95% CI 1.01-1.74 P<0.050). Private insurance payers were more likely to undergo SWL (aOR 11.0, 95% CI 7.26-16.8, P<0.0001) than public insurance payers. Patients in higher median income brackets are significantly less likely to undergo PCNL than those in the <$40,000 income bracket (P<0.0001). CONCLUSION Our study suggests that socioeconomic status impacts urolithiasis surgical management, underscoring disparity recognition importance in endourologic care and ensuring appropriate surgical care regardless of socioeconomic status.

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