Do Social Determinants of Health Affect Adherence to the 2014 American Urological Association Cryptorchidism Guideline? A Multi-Institutional Evaluation

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.