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Do Social Determinants of Health Affect Adherence to the 2014 American Urological Association Cryptorchidism
Julie R Solomon1, Piroz Bahar2, Andrew Bisenius3
1Department of Urology, Washington University, St Louis, Missouri.
Insights
Boys with cryptorchidism in underserved areas received earlier ultrasounds and referrals. Healthcare access significantly impacts adherence to pediatric urology guidelines for cryptorchidism care.
Area of Science:
- Pediatric Urology
- Healthcare Access Research
- Quality of Care Studies
Background:
- The 2014 American Urologic Association Cryptorchidism Guidelines have not demonstrably improved ultrasonography use or referral timing.
- Local healthcare access indicators may influence adherence to these quality-of-care metrics.
Purpose of the Study:
- To investigate the association between local healthcare access indicators and the utilization of pre-evaluation ultrasonography and referral timing for cryptorchidism.
- To understand disparities in cryptorchidism care influenced by geographic and socioeconomic factors.
Main Methods:
- Retrospective analysis of 3,243 boys with cryptorchidism across four institutions (2013, 2015, 2019).
- Assessment of local healthcare access using patient zip codes linked to rural and health shortage area data.
- Statistical evaluation using univariate generalized linear mixed models to assess associations.
Main Results:
- Boys from rural and health shortage areas were more likely to have pre-evaluation sonography but were referred at a younger age.
- Conversely, boys with private insurance, near referral centers, or from wealthier counties were less likely to undergo sonography.
- Significant associations were found between socioeconomic factors and both diagnostic imaging and referral timing.
Conclusions:
- Children with cryptorchidism in rural, poorer, and underserved areas received pre-evaluation ultrasounds more frequently but were referred younger.
- Healthcare access availability and socioeconomic factors play a complex role in guideline adherence for cryptorchidism care.
- The drivers of guideline-adherent care for cryptorchidism vary based on the specific care component and local healthcare landscape.
Introduction:
Evidence shows that the 2014 AUA Cryptorchidism Guidelines have not influenced the use of ultrasonography before urologic evaluation or referral timing. We evaluated whether local indicators of health care access are associated with these quality-of-care indicators.
Methods:
Boys referred in 2013, 2015, and 2019 for cryptorchidism at 4 institutions were retrospectively analyzed. Local indicators of health care access were assessed by cross-referencing patient zip codes to the Rural Health Information and Health Resources and Service Administration websites. Using univariate generalized linear mixed models, we evaluated the association of geocoded factors to the likelihood of preevaluation sonography and mean age at referral.
Results:
A total of 3243 patients were evaluated. Boys from rural and designated health shortage areas were more likely to undergo sonography (odds ratio [OR], 1.38, 95% CI, 1.06-1.81 and OR, 20.5, 95% CI, 4.83-87.2, respectively) yet more likely to be referred at a younger age (OR, 0.87, 95% CI, 0.78-0.97 and OR, 0.70, 95% CI, 0.53-0.93). Conversely, boys with private insurance (OR 0.48, 95% CI, 0.27-0.86) and those residing near a referral center (OR, 0.53, 95% CI, 0.42-0.66) or from wealthier counties (OR, 0.42, 95% CI, 0.30-0.59) were less likely to undergo sonography.
Conclusions:
Boys with cryptorchidism living in rural, poorer, and medically underserved areas were more likely to receive a preevaluation ultrasound yet were more likely to be referred to a pediatric urologist at a younger age than their counterparts. Drivers of guideline-adherent care may differ depending on the care component and local health care access availability.
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