Introduction: Living in socioeconomically disadvantaged neighborhoods affects health behaviors and outcomes. How neighborhood disadvantage impacts care of benign urologic disease has not been previously studied. In this pilot study, we sought to evaluate how patient-level social risk determinants impact care of urethral stricture patients. Methods: Patients treated with urethroplasty between 9/4/2019 and 12/29/2021 were analyzed. Those with a history of urethroplasty and under the age of 18 were excluded. To evaluate neighborhood disadvantage, we used the area deprivation index (ADI), a 17-component index composed of education, employment, housing-quality, and poverty measures utilizing data from the American Community Survey. Patient addresses were geocoded and assigned a national ADI rank, with scores normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. For this analysis, patients were grouped into ADI quartiles. Multiple endoscopic procedures was defined as >2 procedures prior to urethroplasty. Impact of ADI on treatment and processes of care was analyzed utilizing univariate and multivariate models. Results: 104 patients were included, with a median age 54.5 (IQR 38, 66) and ADI of 63.5 (IQR 38.8, 79.3). When separated into quartiles, 15.4%, 21.2%, 31.7% and 31.7% were in the first, second, third and fourth ADI quartiles, respectively, with higher quartiles representing increased levels of deprivation. There were no significant differences in race or insurance status by ADI quartile. Patients in the highest ADI quartile underwent significantly more endoscopic procedures prior to urethroplasty than those in the lowest, at 0 (0, 1) versus 2 (1, 4) (p=0.01). On multivariate analysis adjusting for age and insurance status, ADI quartile was associated with an increased likelihood of undergoing multiple endoscopic procedures, with OR 4.97 (95% CI 1.22-26.14) and OR 5.05 (95% CI 1.23 – 26.53) for third and fourth quartiles, respectively. A one-point increase in ADI was associated with a 2% increased risk of repeat endoscopic procedures prior to urethroplasty (OR 1.02 [95% CI 1.01 – 1.04]). Conclusions: This is the first analysis evaluating how a patient’s physical neighborhood can mediate processes of care for urethral stricture disease. We found that increased neighborhood deprivation, regardless of race or insurance status, can lead to increased endoscopic treatments and delays to urethroplasty. Utilization of this methodology can help further identify disparities in care and highlight the impact of social determinants on urologic care. SOURCE OF Funding: None
