PD14-06 SOCIOECONOMIC DISPARITY IMPACTS URINARY STONE DISEASE MANAGEMENT WITHIN CHARLOTTE-MECKLENBURG ZIP CODES

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (PD14)1 Apr 2020PD14-06 SOCIOECONOMIC DISPARITY IMPACTS URINARY STONE DISEASE MANAGEMENT WITHIN CHARLOTTE-MECKLENBURG ZIP CODES Sagar Patel*, Cameron Futral, Hemal Patel, Rupali Bose, James Kearns, Peter Clark, and Ornob Roy Sagar Patel*Sagar Patel* More articles by this author , Cameron FutralCameron Futral More articles by this author , Hemal PatelHemal Patel More articles by this author , Rupali BoseRupali Bose More articles by this author , James KearnsJames Kearns More articles by this author , Peter ClarkPeter Clark More articles by this author , and Ornob RoyOrnob Roy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000848.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary stone disease affects approximately 10% of the United States (US) population. For symptomatic disease, surgical interventions, including ureteroscopy (URS), extracorporeal shockwave lithotripsy (ESWL), and percutaneous nephrolithotomy (PCNL), are performed. The aim of this study is to determine whether income, race, and payer type are associated with type of urinary stone intervention in the Charlotte-Mecklenburg zip codes. METHODS: A population-based, retrospective study was conducted using the Atrium Health urinary stone disease dataset from 2005-2018. We identified all patients who underwent URS, ESWL, and PCNL within Charlotte-Mecklenburg zip codes. 2017 US census data were used to approximate poverty status and median income per zip codes. Chi-square testing was used for categorical variables, including median income brackets, gender, race, and payer status. Simple linear regression models were used for continuous variables including percent below poverty line and median income. Statistical significance was defined as p < 0.05. RESULTS: Over the study period, 7,739 patients underwent stone disease management in Charlotte-Mecklenburg zip codes. 5,180 (66.9%) cases were URS, 2,162 (27.9%) cases were ESWL, and 397 (5.2%) cases were PCNL. Compared to Whites in Charlotte, Blacks and other races underwent URS and PCNL more frequently and ESWL less commonly (P < 0.01). A larger portion of females than males underwent PCNL and URS (P < 0.01). Compared to private insurance, public insurance payers used ESWL less frequently but USE more frequently (P < 0.01). On linear regression analysis, median zip code income was positively correlated with proportion of EWSL procedures performed per total stone disease cases in corresponding zip codes (R2 = 56.6%, P < 0.01). In contrast, median zip code income was negatively associated with the proportion of URS and PCNL procedures performed compared to total stone disease cases per zip code (R2 = 40.9%, P < 0.01 and R2 = 41.2%; P < 0.01, respectively). Similarly, percent below poverty line per zip code was positively associated with percentage of URS and PCNL per zip code and negatively associated with percentage of ESWL per zip code (R2 = 35.1%, = 61.9%, and 60.2%, respectively; P < 0.01). CONCLUSIONS: Underinsured, minority, and low-income patients are more likely to undergo more invasive and costly stone disease treatment options, such as URS and PCNL. We hypothesize that access to care, inadequate follow-up, and healthcare expenses may play a role in this stone disease management disparity and ultimately exacerbate healthcare expenses. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e274-e274 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sagar Patel* More articles by this author Cameron Futral More articles by this author Hemal Patel More articles by this author Rupali Bose More articles by this author James Kearns More articles by this author Peter Clark More articles by this author Ornob Roy More articles by this author Expand All Advertisement PDF downloadLoading ...