Neighborhood Socioeconomic Disadvantage is Associated with Worse Urinary Risk Factors and Access to Medical Management for Urolithiasis

Abstract

Introduction:

Medical management of recurrent kidney stones utilizes 24-hour urine testing to guide counseling and therapy. Poor socioeconomic status is a well-established risk factor for urolithiasis; however, associations are often based on complex statistics not readily accessible in clinical practice. Area Deprivation Index (ADI) is a quantitative measure of socioeconomic status based on United States census variables reflecting neighborhood disadvantage and is reportable in the electronic medical record. This study aimed to characterize relationships between ADI and metabolic risk factors for urolithiasis.

Materials and Methods:

Retrospective review of patients undergoing percutaneous nephrolithotomy (PCNL) from 2017 to 2022 was performed. Addresses were geocoded to national ADI scores, with the lowest quartile (scores 1–25) representing the least, and the top quartile (76–100) the most disadvantaged. Demographics, comorbidities, 24-hour urine parameters, stone composition, and stone prevention medication prescriptions were evaluated.

Results:

A total of 1859 patients underwent PCNL during the study period, of whom 900 completed a 24-hour urine study. There were more female and black patients (55.3% vs 42.2% p = 0.032; 16.2% vs 3.9% p < 0.001, respectively) in the most disadvantaged quartile. Patients with a higher ADI were less likely to undergo 24-hour urine testing compared with the least disadvantaged quartile (44.2% vs 63.6%, p < 0.001). Higher ADI score was also associated with lower 24-hour urine volume and citrate.

Conclusions:

Higher ADI is associated with multiple risk factors for recurrent urolithiasis including lower 24-hour urine study completion rate, low urinary volume, and hypocitraturia. ADI may serve as a simple clinical tool to identify patients in high need of metabolic stone prevention and more comprehensive endourologic care.