Racial Disparities in Testicular Torsion

Background: Testicular torsion (TT) is a surgical emergency requiring prompt intervention to preserve testicular function. Race and insurance status are thought to be associated with higher rates of gonadal loss; however, reports in the literature are conflicting. We sought to determine the effect of race on the treatment and outcomes of testicular torsion.

Methods: Following IRB approval, a retrospective review was conducted of patients <18 years of age who presented to 2 institutions (hereby referred to as H1 and H2) with acute scrotal pain between December 2017 and September 2019. Demographic data, clinical history, imaging results, diagnosis, and surgical outcomes were recorded. Social vulnerability index (SVI), as determined by zip code, was obtained from the Centers for Disease Control and dichotomized using the 75th percentile. Higher SVI denotes increased social vulnerability. Primary outcome was diagnosis of TT. Secondary outcomes included orchiectomy rates. A p-value <0.05 was considered significant.

Results: A total of 515 patients (H1 85%, H2 15%) were included in the final analysis. There were no differences in median age, BMI, TT diagnosis and orchiectomy rate between the two institutions. H2 treated more black patients (43% vs. 14%, p= <0.01) and patients with public insurance (57% vs. 41%, p=0.03) compared to H1. In multivariate analysis, older age was associated with TT (median age TT 14.12 years [12.13,15.69]) vs. no TT 9.86 years [5,13.05], OR 1.35, 95% CI 1.18-1.55, p= <0.01). Black patients were ~4 times more likely (OR 4.05, 95% CI 2.13-7.69, p= <0.01) than white patients to be diagnosed with TT when controlled for dichotomized SVI, insurance, and age. In the same model, Hispanic patients were ~2 times more likely (OR 2.20, 95% CI 1.10-4.40, p=0.03) to be diagnosed with TT when compared to white patients. Despite more black and Hispanic patients having dichotomized SVI >75th percentile than white patients (70% and 82%, respectively vs. 16%, p= <0.01), dichotomized SVI was not found to be associated with higher rates of TT or orchiectomy, respectively.

Conclusion: At the two centers, more black and Hispanic children had SVI >75th percentile, however, when controlling for this in multivariate analysis, they were significantly more likely to be diagnosed with testicular torsion. Conversely, there was no difference in orchiectomy rate between races.