Narang Gopal L, Wiener Laura E, Penniston Kristina L, Antonelli Jodi A, Averch Timothy D, Sivalingam Sri, Chew Ben H, Bird Vincent G, Pais Vernon M, Sur Roger L, Chi Thomas, Streeper Necole M, Nakada Stephen Y, Koch Gary G, Viprakasit Davis P
University of North Carolina School of Medicine, Chapel Hill, NC, United States.
Department of Biostatistics, University of North Carolina, Chapel Hill, NC, United States.
Can Urol Assoc J. 2020 Apr;14(4):99-104. doi: 10.5489/cuaj.6090. Epub 2019 Nov 5.
Urolithiasis causes a significant impact on health-related quality of life (HRQOL). Patients with kidney stones have high levels of stress and anxiety. Symptom resolution often requires treatment. Travel distance is a barrier to care but little is known about its effects on HRQOL. We hypothesize that increased distance to treatment site is associated with decreased HRQOL.
Patients with a history of stones were enrolled at 11 tertiary centers as part of the QOL Stone Consortium of North America. HRQOL data were obtained using the Wisconsin Stone Quality of Life questionnaire (WISQOL). We calculated distance between patient and treatment site using national ZIP codes. We used linear models to evaluate the effect of distance on HRQOL, while also considering demographics data, stones/symptom status, and distance.
Of the 1676 enrolled patients, 52% were male, 86% non-Latino White, and the mean age was 53 years. Mean distance to treatment site was 63.3 km (range 0-3774), with 74% reporting current stones and 45% current symptoms. WISQOL score and distance were negatively correlated for patients reporting current stones and symptoms (p=0.0010). Linear modelling revealed decreased WISQOL scores for patients with symptoms as distance increased from treatment site (p=0.0001), with a 4.7-point decrease for every 100 km traveled.
Stone disease imposes significant burden on patients' HRQOL due to a variety of factors. Patients with active stone symptoms report worse HRQOL with increased distance to their treatment site. Possible etiologies include travel burden, increased disease burden, decreased healthcare use, and delays in care.
尿石症对健康相关生活质量（HRQOL）有重大影响。肾结石患者存在高度的压力和焦虑。症状缓解通常需要治疗。就诊距离是获得医疗服务的一个障碍，但人们对其对HRQOL的影响知之甚少。我们假设，到治疗地点的距离增加与HRQOL下降有关。
作为北美生活质量结石联盟的一部分，在11个三级医疗中心招募有结石病史的患者。使用威斯康星结石生活质量问卷（WISQOL）获取HRQOL数据。我们利用全国邮政编码计算患者与治疗地点之间的距离。我们使用线性模型评估距离对HRQOL的影响，同时考虑人口统计学数据、结石/症状状态和距离。
在1676名登记患者中，52%为男性，86%为非拉丁裔白人，平均年龄为53岁。到治疗地点的平均距离为63.3公里（范围0 - 3774公里），74%的患者报告目前有结石，45%的患者有当前症状。对于报告有当前结石和症状的患者，WISQOL评分与距离呈负相关（p = 0.0010）。线性模型显示，随着与治疗地点距离的增加，有症状患者的WISQOL评分下降（p = 0.0001），每行进100公里下降4.7分。
由于多种因素，结石病给患者的HRQOL带来了重大负担。有活动性结石症状的患者报告称，随着与治疗地点距离的增加，HRQOL更差。可能的病因包括出行负担、疾病负担增加、医疗服务利用减少和就医延迟。
