Introduction: Studies suggest that there is a disproportionately increasing prevalence of kidney stone disease among African American and Hispanic patients in the United States. Furthermore, evidence indicates that disparities exist in the workup, management, and surgical interventions of different diseases based on race, ethnicity and socioeconomic status, among other variables. We sought to explore the potential non-clinical factors that could lead to disparities in the management of patients with symptomatic nephrolithiasis at a tertiary care center serving a mixed urban and non-urban population. Methods: We retrospectively analyzed consecutive non-established adult patients presenting with symptomatic unilateral nephrolithiasis requiring definitive ureteroscopic stone extraction at a single institution between October 2019 and September 2021. The primary endpoint was time in days from the date of referral to the date of definitive treatment. Other variables included patient demographics, clinical characteristics, need for preoperative decompression, referral source, treatment date in relation to the COVID-19 pandemic, and Area Deprivation Index (ADI) ranking, a validated measure of neighborhood adversity related to education, employment, housing, and income. Results: Of 398 included patients, the mean age was 53 years, 55% female and 75% Caucasian. 47% had private insurance, 40% had government assistance and 13% were uninsured. The majority (73%) of referrals were from the emergency department. 10% of patients had a urinary tract infection on presentation. Renal obstruction was present in 77% of patients with 40% requiring preoperative decompression. The overall mean time from referral to surgery was 29 days (IQR 15-36). Factors associated with significantly longer time to surgery included Hispanic identity (40 days IQR 12-68, p=0.0098) compared to other ethnicities, Medicaid insurance (36 days IQR 17-55, p=0.012) compared to other payer groups and patients within the highest tertile ADI (most disadvantaged) ranking (+8 days, p=0.022) compared to those in the lowest tertile (most advantaged). Conclusions: In our cohort we demonstrated several non-clinical factors that resulted in a delay to definitive treatment in symptomatic kidney stone patients including Hispanic identity, Medicaid insurance, and most disadvantaged ADI ranking. Recognition of such disparities is the first step to help delineate and eliminate the barriers delaying the care of these vulnerable patients. SOURCE OF Funding: None
