(311) Socioeconomic Risk-Adjustment with Area Deprivation Index (ADI) Predicts Delays to Urethroplasty for Patients with Urethral Stricture Disease

Abstract

Abstract Introduction Treatment of urethral stricture disease with multiple repeated endoscopic procedures has been shown to be both ineffective and costly. While a number of patient and provider factors are known to be associated with likelihood of undergoing multiple endoscopic, little is known about non-clinical factors that can impact care. Objective As social inequalities such as living in a disadvantaged neighborhood are known to be associated with poorer overall health, worse health outcomes, and decreased quality of care, the aim of this study was to assess whether neighborhood deprivation is associated with delays to definitive care for urethral stricture disease. Methods This study identified patients treated by a single surgeon with urethroplasty between 9/4/2019 and 12/29/2021. Patients with a previous history of urethroplasty, under the age of 18, and those with insufficient follow-up data were excluded from the study. Area deprivation index (ADI) is a composite comprised of 17 factors describing income, education, employment and housing quality based on subject 9-digit ZIP code and obtained from the University of Wisconsin School of Medicine and Public Health Neighborhood Atlas. Scores are normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. Patient addresses were geocoded and assigned a national ADI rank based on residential census block group. For the present study, ADI rank was sub-grouped into least disadvantaged (lower 50%) and most disadvantaged (upper 50%). Multivariate logistic regression was performed to assess impact of ADI score on likelihood of receiving multiple endoscopic procedures prior to urethroplasty. Final model was assessed for multicollinearity and goodness of fit via Hosmer-Lemeshow goodness-of-fit test. Results 104 patients were included in the final analysis. 44% of patients had undergone multiple prior endoscopic procedures. Patients who had undergone ≥2 endoscopic procedures tended to be older, have higher ADI scores, and were more likely to be white. Median time to urethroplasty was significantly higher in those who had undergone multiple prior endoscopic procedures (88 mos vs 12 mos, p<0.001). On multivariate analysis adjusting for age, ADI classification, and insurance status, patients in the more disadvantaged group were significantly more likely to have undergone multiple endoscopic procedures prior to urethroplasty (OR 2.79), as were older patients (OR 1.04). Conclusions Neighborhood disadvantage as assessed by the ADI provides an alternative methodology to identify disparities in health services utilization in patients with urethral stricture disease. These findings highlight needs to increase provision of urologic resources and care to disadvantaged communities. Disclosure No