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Prenatal Urologic Consultation for Prenatal Hydronephrosis: True Equity or Hidden Disparity?
Aiden Hoefer1, Meridiana Mendez1, Gemima Nanizao1
1Division of Urology, Seattle Children's Hospital, Seattle, Washington.
Insights
Prenatal urologic consultation (PUC) for fetal hydronephrosis (PH) is linked to earlier postnatal care. However, access disparities exist based on socioeconomic factors, highlighting the need for further research into equitable care.
Area of Science:
- Pediatric Urology
- Fetal Medicine
- Health Services Research
Background:
- Prenatal urologic consultation (PUC) is increasingly offered for fetal prenatal hydronephrosis (PH).
- Understanding disparities in care access is crucial for improving outcomes in PH patients.
- Socioeconomic and community factors may influence the utilization of PUC.
Purpose of the Study:
- To analyze patient- and community-level differences in prenatal and postnatal urologic care for PH.
- To identify modifiable factors impacting timely access to prenatal urologic consultation.
- To evaluate the association between PUC and early postnatal urologic evaluation.
Main Methods:
- Retrospective review of 250 patients with PH (age <6 months) from January 2021 to December 2022.
- Data collected included patient demographics, PH characteristics, and socioeconomic status (Area Deprivation Index).
- Comparison of patients with and without prenatal urologic consultation (PUC).
Main Results:
- Patients with PUC received earlier postnatal evaluation (0.62 months vs. 2.1 months, P < 0.0001).
- PUC rates were not significantly different based on PH laterality, language, or race.
- Children in less disadvantaged areas (lower Area Deprivation Index) had higher PUC rates compared to those in most disadvantaged areas.
Conclusions:
- Prenatal urologic consultation is associated with earlier postnatal urologic evaluation.
- Significant disparities in PUC access were observed related to neighborhood disadvantage.
- Further research is needed to address low PUC utilization in specific patient subgroups and improve equitable access to care.
Introduction:
Prenatal urologic consultation (PUC) is now offered to many prospective parents for fetal prenatal hydronephrosis (PH). This study aims to describe patient- and community-level differences in prenatal and postnatal urologic care patterns for patients with PH and to identify potentially modifiable factors that would improve timely access to care.
Methods:
We identified all patients with PH aged <6 mos seen at a single freestanding children's hospital from January 2021 to December 2022. Data were collected on patient gender, race/ethnicity, characteristics of upper tract dilatation, timing of delivery, and socioeconomic status. Patients with and without PUC were compared.
Results:
Two hundred and fifty patients met inclusion criteria. One hundred seventy-nine (71.6%) were male, 122 (48.8%) were White, and 56 (22.4%) had PUC. Patients with PUC had postnatal evaluation earlier than those without PUC (0.62 [0.2-5.0] versus 2.1 [0.1-12.8] months (P < 0.0001) but were equally likely to have bilateral PH (41.1% versus 41.2%, P = 0.73). Patients speaking English (54/229; 23.6%) and other languages (LOE; 2/21; 9.5%) were equally likely to have PUC. Children living in the least (Area Deprivation Index [ADI], 1-2) and moderately disadvantaged areas (ADI, 3-8) were equally (odds ratio [OR] = 1.52; 95% confidence interval [CI]: 0.55-4.23) and three times (OR = 2.99; 95% CI: 1.16-7.67) as likely to have PUC as those living in the most disadvantaged areas (ADI, 9-10), respectively. Of preterm infants, 25% of those living in ADI 1-2 had PUC, compared with 0% of those living in ADI 9-10 (OR = 3.32; 95% CI, 0.57-11.4), and 24% of those speaking English had PUC, compared with 0% of those with LOE (OR = 1.98; 95% CI, 0.09-45.6). The likelihood of PUC for patients with bilateral PH was similar for patients living in ADI 1-2 (6/33; 18.2%) and ADI 9-10 (2/19; 10.5%; OR = 1.89 [95% CI, 0.34-10.45]) and for those speaking English (23/96; 24%) and LOE (0/7; 0%; OR = 4.80 [95% CI, 0.26-87.2]).
Conclusions:
PUC is associated with earlier postnatal urologic evaluation, but-in our series-not with PH laterality, language, race, or lowest levels of neighborhood disadvantage. However, the proportion with and without PUC in certain subgroups was notably low. Further research centering on patient groups with low PUC utilization may identify patient- and community-level factors associated with differential access to care.
