Department of Urology, UC San Diego Health, San Diego, USA.
Department of Urology, University of Wisconsin, Madison, USA.
Urolithiasis. 2023 Mar 15;51(1):48. doi: 10.1007/s00240-023-01414-w.
It is documented that Hispanic/Latinx kidney stone formers have inferior health-related quality of life (HRQoL) compared to the general population. We hypothesized that socioeconomic factors drive HRQoL disparities. Specifically, we sought to determine if medical insurance type is associated with HRQoL disparities among Hispanic/Latinx stone formers. This was a prospective cohort observational study of patients with kidney stones across the University of San Diego Health Care System. Patients enrolled from June 2018 to August 2020 completed a validated Wisconsin Stone Quality of Life questionnaire (WISQoL). Patient characteristics and self-reported HRQoL were compared between Hispanic/Latinx and non-Hispanic/Latinx stone formers using MANCOVA and ordinal logistic regression. Matched group comparisons were performed based on age, gender, body mass index, stone symptoms, and insurance type using MACOVA. A total of 270 patients were enrolled (Hispanic/Latinx n = 88; non-Hispanic/Latinx n = 182). Hispanic/Latinx stone formers had higher rates of public insurance at baseline (p < 0.001) with significantly lower HRQoL [social impact (p = 0.007)]. However, a matched cohort comparison demonstrated no differences. On multivariate analysis, private insurance increased the likelihood of having higher HRQoL (OR 2.21, p = 0.021), while stone symptoms (OR = 0.06, p < 0.001) and emergency department visits (OR = 0.04, p = 0.008) decreased chances of higher HRQoL. Ethnicity was not a significant factor in HRQoL scores on multivariate analysis. Our analysis suggests that differences in HRQoL among Hispanic/Latinx stone formers may be primarily driven by socioeconomic factors as opposed to clinical or racial differences. Specifically, source of insurance appears to have significant effect on HRQoL in this ethnic group.
有文献记载，与普通人群相比，西班牙裔/拉丁裔肾结石患者的健康相关生活质量（HRQoL）较差。我们假设社会经济因素导致 HRQoL 存在差异。具体而言，我们试图确定医疗保险类型是否与西班牙裔/拉丁裔肾结石患者的 HRQoL 差异相关。这是一项针对圣迭戈大学医疗保健系统内肾结石患者的前瞻性队列观察研究。2018 年 6 月至 2020 年 8 月期间，患者完成了经过验证的威斯康星结石生活质量问卷（WISQoL）。使用 MANCOVA 和有序逻辑回归比较西班牙裔/拉丁裔和非西班牙裔/拉丁裔肾结石患者的患者特征和自我报告的 HRQoL。使用 MACOVA 根据年龄、性别、体重指数、结石症状和保险类型对匹配组进行比较。共纳入 270 例患者（西班牙裔/拉丁裔 n=88；非西班牙裔/拉丁裔 n=182）。西班牙裔/拉丁裔肾结石患者在基线时公共保险的比例更高（p<0.001），HRQoL 明显更低[社会影响（p=0.007）]。然而，匹配组比较表明没有差异。多变量分析表明，私人保险增加了 HRQoL 更高的可能性（OR 2.21，p=0.021），而结石症状（OR=0.06，p<0.001）和急诊科就诊（OR=0.04，p=0.008）降低了 HRQoL 更高的可能性。在多变量分析中，种族不是 HRQoL 评分的重要因素。我们的分析表明，西班牙裔/拉丁裔肾结石患者之间 HRQoL 的差异可能主要是由社会经济因素而不是临床或种族差异驱动的。具体而言，保险来源似乎对该族裔群体的 HRQoL 有重大影响。
