Faculty Collaboration Database

Do Social Determinants of Health Affect Adherence to the 2014 American Urological Association Cryptorchidism Guideline? A Multi-Institutional Evaluation. Urol Pract 2025 Sep;12(5):507-516

Date

04/15/2025

Pubmed ID

40233173

DOI

10.1097/UPJ.0000000000000819

Scopus ID

2-s2.0-105014994238 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

INTRODUCTION: Evidence shows that the 2014 AUA Cryptorchidism Guidelines have not influenced the use of ultrasonography before urologic evaluation or referral timing. We evaluated whether local indicators of health care access are associated with these quality-of-care indicators.

METHODS: Boys referred in 2013, 2015, and 2019 for cryptorchidism at 4 institutions were retrospectively analyzed. Local indicators of health care access were assessed by cross-referencing patient zip codes to the Rural Health Information and Health Resources and Service Administration websites. Using univariate generalized linear mixed models, we evaluated the association of geocoded factors to the likelihood of preevaluation sonography and mean age at referral.

RESULTS: A total of 3243 patients were evaluated. Boys from rural and designated health shortage areas were more likely to undergo sonography (odds ratio [OR], 1.38, 95% CI, 1.06-1.81 and OR, 20.5, 95% CI, 4.83-87.2, respectively) yet more likely to be referred at a younger age (OR, 0.87, 95% CI, 0.78-0.97 and OR, 0.70, 95% CI, 0.53-0.93). Conversely, boys with private insurance (OR 0.48, 95% CI, 0.27-0.86) and those residing near a referral center (OR, 0.53, 95% CI, 0.42-0.66) or from wealthier counties (OR, 0.42, 95% CI, 0.30-0.59) were less likely to undergo sonography.

CONCLUSIONS: Boys with cryptorchidism living in rural, poorer, and medically underserved areas were more likely to receive a preevaluation ultrasound yet were more likely to be referred to a pediatric urologist at a younger age than their counterparts. Drivers of guideline-adherent care may differ depending on the care component and local health care access availability.

Author List

Solomon JR, Bahar P, Bisenius A, Duncan M, Price DK, Paradis AG, Vetter J, Hansen JD, Wendt L, Ten Eyck P, Kraft KH, Traxel E, Ellison JS, Storm DW

Author

Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child
Child, Preschool
Cryptorchidism
Guideline Adherence
Health Services Accessibility
Humans
Infant
Male
Practice Guidelines as Topic
Referral and Consultation
Retrospective Studies
Social Determinants of Health
Societies, Medical
Ultrasonography
United States
Urology