PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX Evan Watkins, Abimbola Ayangbesan, George Koch, Rohan Bhalla, Jackson Cabo, Helen Gambrah, Theresa Zwaschka, and Niels Johnsen Evan WatkinsEvan Watkins More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Helen GambrahHelen Gambrah More articles by this author , Theresa ZwaschkaTheresa Zwaschka More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Living in socioeconomically disadvantaged neighborhoods affects health behaviors and outcomes. How neighborhood disadvantage impacts care of benign urologic disease has not been previously studied. In this pilot study, we sought to evaluate how patient-level social risk determinants impact care of urethral stricture patients. METHODS: Patients treated with urethroplasty between 9/4/2019 and 12/29/2021 were analyzed. Those with a history of urethroplasty and under the age of 18 were excluded. To evaluate neighborhood disadvantage, we used the area deprivation index (ADI), a 17-component index composed of education, employment, housing-quality, and poverty measures utilizing data from the American Community Survey. Patient addresses were geocoded and assigned a national ADI rank, with scores normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. For this analysis, patients were grouped into ADI quartiles. Multiple endoscopic procedures was defined as >2 procedures prior to urethroplasty. Impact of ADI on treatment and processes of care was analyzed utilizing univariate and multivariate models. RESULTS: 104 patients were included, with a median age 54.5 (IQR 38, 66) and ADI of 63.5 (IQR 38.8, 79.3). When separated into quartiles, 15.4%, 21.2%, 31.7% and 31.7% were in the first, second, third and fourth ADI quartiles, respectively, with higher quartiles representing increased levels of deprivation. There were no significant differences in race or insurance status by ADI quartile. Patients in the highest ADI quartile underwent significantly more endoscopic procedures prior to urethroplasty than those in the lowest, at 0 (0, 1) versus 2 (1, 4) (p=0.01). On multivariate analysis adjusting for age and insurance status, ADI quartile was associated with an increased likelihood of undergoing multiple endoscopic procedures, with OR 4.97 (95% CI 1.22-26.14) and OR 5.05 (95% CI 1.23 – 26.53) for third and fourth quartiles, respectively. A one-point increase in ADI was associated with a 2% increased risk of repeat endoscopic procedures prior to urethroplasty (OR 1.02 [95% CI 1.01 – 1.04]). CONCLUSIONS: This is the first analysis evaluating how a patient’s physical neighborhood can mediate processes of care for urethral stricture disease. We found that increased neighborhood deprivation, regardless of race or insurance status, can lead to increased endoscopic treatments and delays to urethroplasty. Utilization of this methodology can help further identify disparities in care and highlight the impact of social determinants on urologic care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e911 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evan Watkins More articles by this author Abimbola Ayangbesan More articles by this author George Koch More articles by this author Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Helen Gambrah More articles by this author Theresa Zwaschka More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...