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Association Between Area Deprivation Index and Disparities in Acute Stone Treatment and Prevention: Findings from the AQUA Registry
Muhieddine Labban, MD1, Emily Galen, MS2, Rachel Mbassa, MS3, George Haleblian, MD1, Daniel Wollin, MD, MS1.
1Brigham and Women's Hospital, BOSTON, MA, USA, 2American Urological Association, LINTHICUM, MD, USA, 3American Urological Association Statistical Services, LINTHICUM, MD, USA.
BACKGROUND: Area Deprivation Index (ADI) reflects neighborhood socioeconomic disadvantages that can impede care. Herein, we investigated the association of ADI and receipt of alpha‑blocker therapy, stone surgery, and stone prevention medications after first ureteral stone diagnosis.
METHODS: We leveraged the AUA Quality Registry to identify a cohort of adults with a newly diagnosed ureteral stone between 2014-2022 across 42 states. Stones events in pregnancy, solitary kidneys, or renal congenital anomalies were excluded. The exposure was patient-level ADI tertile (high, moderate, and low) based on zip-code level linkages using the Center of Health Disparities Research Neighborhood Atlas. The outcomes included 90-day receipt of alpha-blocker therapy, stone surgery, and stone-prevention medications after first ureteral stone diagnosis. Multivariable logistic regressions were run adjusting for demographics, insurance status, practice settings, patient metropolitan status, and residence in the stone belt.
RESULTS: 1,002,415 patients sought care in predominantly private practice settings. At 90-days, only 4% received alpha-blocker therapy, 24% received a surgical intervention, and 21% received stone prevention medication. Those in higher ADI neighborhoods were more likely to reside in rural areas and/or the stone belt (57%). Compared to low ADI setting, patients in high ADI neighborhoods were 10.4% (7.7%-13.1%; p<0.001) less likely to receive alpha-blocker therapy, 6.5% (5.2%-7.8%; p<0.001) less likely to receive stone-related procedure, and 19.2% (18%-20.4%; p<0.001) less likely to receive stone prevention medications. Compared to academic settings, patients receiving care in private practice settings were more likely to receive stone surgery but less likely to receive acute medical or stone prevention therapy.
CONCLUSIONS: Residence in high ADI neighborhoods is not only associated with barriers to receiving acute medical and surgical stone treatment, but also stone prevention therapy. These inequities in nephrolithiasis care support targeted interventions and policy efforts to improve access and guideline‑concordant management in deprived communities.
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