The Impact of Distressed Community Index on Stone Burden, Prevention, and Quality of Life in Patients With...

To assess the impact of Distressed Communities Index (DCI) on treatment disparities and disease-related quality of life (QoL) in a nationwide sample of patients with nephrolithiasis.

We performed a nationwide online cross-sectional survey of adult registrants of ResearchMatch with nephrolithiasis. Patients from distressed communities (DCI ≥75) were compared to patients from not distressed communities. Stone burden, prevention recommendations, stone-related QoL (WISQOL), and patient-reported barriers to prevention were compared. Multivariable linear regression was used to evaluate the association between DCI and WISQOL scores, adjusting for demographics, emergency care, and income.

Of the 938 respondents in this cohort, 126 (13.4%) were from distressed communities (DCI ≥75). Individuals from distressed communities had significantly lower WISQOL scores (median WISQOL 83 [IQR 55.7-92] vs 87.5 [IQR 68.8-94.6]; P = .005), were more likely to miss ≥5 workdays due to nephrolithiasis (17.5% vs 8.4%; P = .003) and report barriers to making stone-prevention dietary changes (44.4% vs 29.2%; P<.001), primarily due to cost. On multivariable analysis, after controlling for demographics and emergency care utilization, DCI remained inversely correlated with WISQOL; however, upon the addition of income, this association was attenuated.

In this nationwide study, patients from distressed areas faced additional barriers to stone prevention and lower stone-related QoL, though this relationship was primarily driven by income. These findings suggest that community-level socioeconomic distress associated with disparities among patients with stones and may help urologists tailor more equitable and supportive care strategies.