PD35-04: Initial Surgical Report Using Distressed Communities Index: Evidence of Larger Stone Size and Greater Need for Percutaneous Intervention in Patients with Low Socioeconomic Status

Scott Quarrier, Shuang Li, Sara Best, Sean Hedican, Kristina Penniston, Stephen Nakada

Introduction: Distressed Communities Index (DCI) is used as a measure for socioeconomic status and is tied to health outcomes. Factors included in the calculation for DCI: employment status, education level, poverty rate, median income, business growth and housing vacancies utilizing zip codes.

Methods: An IRB approved prospectively maintained surgical database for renal and ureteral stones at a referral center was retrospectively analyzed for surgical procedures performed from 2009 to 2019. Severely distressed communities (SDC) were those with a DCI score in the top quartile >75. Stone size was determined by preoperative imaging using linear diameter. Procedures were determined to be staged if a subsequent procedure was performed on the ipsilateral side within a 6-month period. Analysis was performed on a per surgical procedure basis. ANOVA and chi squared tests were performed. Exclusion criteria included age<18 and/or no pre-operative stone size available.

Results: Surgical procedures were performed on 3939 patients (1961 men and 1978 women) who were not from SDC and 200 (103 men and 97 women) from SDC. Patients from SDC were older compared to those not from SDC (57.1 vs 54.2; p<0.01). BMI, gender and race were similar among the two groups (p>0.05). Diabetes (32% SDC and 23% non-SDC; p<0.01) and hypertension (52% SDC and 42% non-SDC; p<0.01) were more prevalent in the patients from SDC. Patients from SDC were more likely to undergo PCNL (17.5% vs 11.6%; p=0.01) and require staged surgery (13% vs 9%; p=0.02). Men from SDC had a significantly larger stone size (12.5mm vs 9.7mm; p<0.01). Men from SDC had a higher prevalence of stones >20mm (20% vs 8%; p<0.01).  Stone size was not different for women between groups (10.4mm vs 10.8; p=0.56).

Conclusions: Our study demonstrates socioeconomic status correlates with larger stone burden at the time of urologic intervention, require proportionally more invasive procedures (PCNL) and more staged procedures. Socioeconomic status appears to affect stone size in men more than women. Source of

Funding: none