Access to Care and Health Care Utilization Among Patients With Nephrolithiasis

Abstract

ObjectiveTo characterize the impact of nephrolithiasis diagnosis and treatment on healthcare utilization and identify predictors of barriers to care in the patient population. MethodsWe conducted a retrospective cohort study using the All of Us Database, an NIH database targeting recruitment of underrepresented populations. Patients with a diagnosis of kidney stones were included and matched to a control group. Primary outcomes were patients’ self-reported healthcare access and utilization. Univariable and multivariable regression analyses were performed. Results9,173 patients with a diagnosis of nephrolithiasis were included and matched to 9,173 controls without a diagnosis of nephrolithiasis. Patients with kidney stones were less likely to have had >1 year since last provider visit (1.7% vs. 3.8%, p<.001), but did not report increased delays obtaining care (31%), inability to afford care (11.4%), or higher likelihood of skipping medications (12.9%). Among patients with stones, 1,208 (13.2%) had been treated surgically. On multivariable analysis, younger age, female sex, lower income, lower education, non-insured status, and lower physical and mental health were all associated with delays obtaining care, difficulty affording care, skipping medications, and/or prolonged time since seeing a provider. ConclusionA diagnosis of nephrolithiasis and subsequent surgical intervention were not associated with an increase in patient-reported barriers to care. However, among patients with nephrolithiasis, younger, comorbid, female patients from lower socioeconomic status are at significant risk of being unable to access and utilize treatment.