Skip to main content

Advertisement

SpringerLink
Log in

Disparities in care among patients presenting to the emergency department for urinary stone disease

  • Original Paper
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

To determine whether patients with ureteral stones received different standard of care in the emergency department (ED) according to various sociodemographic factors. We conducted a retrospective study of patients presenting to EDs in a large tertiary-care hospital in the Bronx, New York with a diagnosis of ureteral stones. Electronic chart review was used to assess each patient’s ED course and to gather socio-demographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage, and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, BMI category, socioeconomic status and insurance status were examined using multivariate logistic regression models. 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities: 40% Hispanic, 15% non-Hispanic Black, and 20% other/multiracial. Patients aged 55–64 years and those 65 or older were less likely to receive pain medication compared to patients < 35 years (OR = 0.48, 95% CI 0.27–0.86, p = 0.01 and OR = 0.46, 95% CI 0.21–1.00, p = 0.05, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR = 0.52, 95% CI 0.35–0.76, p = 0.001). Similarly, patients in the lowest quintile of SES received less imaging than patients in the highest SES group (OR = 0.50, 95% CI 0.27–0.90, p = 0.02). Finally, women were less likely to receive alpha blockade compared to men (OR = 0.68, 95% CI 0.49–0.92, p = 0.014). Multiple disparities exist among patients presenting to the emergency department for ureteral stones.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Antonelli JA, Maalouf NM, Pearle MS, Lotan Y (2014) Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030. Eur Urol 66(4):724–729. https://doi.org/10.1016/j.eururo.2014.06.036

    Article  PubMed  PubMed Central  Google Scholar 

  2. Scales CD Jr, Smith AC, Hanley JM, Saigal CS, Urologic Diseases in America P (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165. https://doi.org/10.1016/j.eururo.2012.03.052

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z (2013) Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney Int 83(3):479–486. https://doi.org/10.1038/ki.2012.419

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pearle MS, Calhoun EA, Curhan GC (2005) Urologic diseases in America project: urolithiasis. J Urol 173(3):848–857. https://doi.org/10.1097/01.ju.0000152082.14384.d7

    Article  PubMed  Google Scholar 

  5. Institute of Medicine Committee on U, Eliminating R, Ethnic Disparities in Health C (2003). In: Smedley BD, Stith AY, Nelson AR (eds) Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press (US)

  6. Copyright 2002 by the National Academy of Sciences. All rights reserved. Washington (DC). https://doi.org/10.17226/12875

  7. Wheeler SM, Bryant AS (2017) Racial and ethnic disparities in health and health care. Obstet Gynecol Clin North Am 44(1):1–11. https://doi.org/10.1016/j.ogc.2016.10.001

    Article  PubMed  Google Scholar 

  8. LaVeist TA, Gaskin D, Richard P (2011) Estimating the economic burden of racial health inequalities in the United States. Int J Health Serv 41(2):231–238. https://doi.org/10.2190/HS.41.2.c

    Article  PubMed  Google Scholar 

  9. Saha S, Freeman M, Toure J, Tippens KM, Weeks C (2007) VA evidence–based synthesis program reports. In: Racial and ethnic disparities in the VA healthcare system: a systematic review. Department of Veterans Affairs (US), Washington (DC),

  10. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R (2008) Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA 299(1):70–78. https://doi.org/10.1001/jama.2007.64

    Article  CAS  PubMed  Google Scholar 

  11. Weisse CS, Sorum PC, Dominguez RE (2003) The influence of gender and race on physicians’ pain management decisions. J Pain 4(9):505–510

    Article  Google Scholar 

  12. Foreman S (2004) Montefiore medical center in the bronx, New York: improving health in an urban community. Acad Med 79(12):1154–1161

    Article  Google Scholar 

  13. Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu–Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM, White JR (2014) Medical management of kidney stones: AUA guideline. J Urol 192(2):316–324. https://doi.org/10.1016/j.juro.2014.05.006

    Article  PubMed  Google Scholar 

  14. Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint S, Wei JT, Hollenbeck BK (2006) Medical therapy to facilitate urinary stone passage: a meta–analysis. Lancet (London, England) 368(9542):1171–1179. https://doi.org/10.1016/s0140-6736(06)69474-9

    Article  Google Scholar 

  15. Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MT (2014) Alpha–blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 4:CD008509. https://doi.org/10.1002/14651858.cd008509.pub2

    Article  Google Scholar 

  16. Lipkin M, Shah O (2006) The use of alpha–blockers for the treatment of nephrolithiasis. Rev Urol 8(Suppl 4):S35–S42

    PubMed  PubMed Central  Google Scholar 

  17. Daoust R, Paquet J, Lavigne G, Sanogo K, Chauny JM (2014) Senior patients with moderate to severe pain wait longer for analgesic medication in EDs. Am J Emerg Med 32(4):315–319. https://doi.org/10.1016/j.ajem.2013.12.012

    Article  PubMed  Google Scholar 

  18. Kaye AD, Baluch A, Scott JT (2010) Pain management in the elderly population: a review. Ochsner J 10(3):179–187

    PubMed  PubMed Central  Google Scholar 

  19. Jones JS, Johnson K, McNinch M (1996) Age as a risk factor for inadequate emergency department analgesia. Am J Emerg Med 14(2):157–160. https://doi.org/10.1016/s0735-6757(96)90123-0

    Article  CAS  PubMed  Google Scholar 

  20. Meghani SH, Byun E, Gallagher RM (2012) Time to take stock: a meta–analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Med (Malden, Mass) 13(2):150–174. https://doi.org/10.1111/j.1526-4637.2011.01310.x

    Article  Google Scholar 

  21. Heins JK, Heins A, Grammas M, Costello M, Huang K, Mishra S (2006) Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs 32(3):219–224. https://doi.org/10.1016/j.jen.2006.01.010

    Article  PubMed  Google Scholar 

  22. Chen EH, Shofer FS, Dean AJ, Hollander JE, Baxt WG, Robey JL, Sease KL, Mills AM (2008) Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med 15(5):414–418. https://doi.org/10.1111/j.1553-2712.2008.00100.x

    Article  PubMed  Google Scholar 

  23. Rikard RV, Thompson MS, McKinney J, Beauchamp A (2016) Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL). BMC Public Health 16:975. https://doi.org/10.1186/s12889-016-3621-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Morrison AK, Brousseau DC, Brazauskas R, Levas MN (2015) Health literacy affects likelihood of radiology testing in the pediatric emergency department. J Pediatr 166(4):1037. https://doi.org/10.1016/j.jpeds.2014.12.009

    Article  PubMed  PubMed Central  Google Scholar 

  25. Innes GD, Scheuermeyer FX, Law MR, McRae AD, Weber BA, Boyda HN, Lonergan K, Andruchow JE (2016) Sex–related differences in emergency department renal colic management: females have fewer computed tomography scans but similar outcomes. Acad Emerg Med 23(10):1153–1160. https://doi.org/10.1111/acem.13041

    Article  PubMed  Google Scholar 

  26. Amer T, Jones G, Aboumarzouk O (2017) Medical expulsive therapy: is it time to suspend judgement? Drugs 77(8):809–812. https://doi.org/10.1007/s40265-017-0721-5

    Article  PubMed  Google Scholar 

  27. Kroczak T, Pace KT, Lee JY (2017) Medical expulsive therapy: worthwhile or wishful thinking. Curr Urol Rep 18(4):29. https://doi.org/10.1007/s11934-017-0673-z

    Article  PubMed  Google Scholar 

  28. Ye Z, Zeng G, Yang H, Tang K, Zhang X, Li H, Li W, Wu Z, Chen L, Chen X, Liu X, Deng Y, Pan T, Xing J, Wang S, Cheng Y, Gu X, Gao W, Yang J, Zhang Y, Mi Q, Qi L, Li J, Hu W, Liang P, Sun Z, Xu C, Long Y, Liao Y, Liu S, Liu G, Xu X, He W, Chen Z, Xu H (2017) Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double–blind, Placebo–controlled Trial. Eur Urol. https://doi.org/10.1016/j.eururo.2017.10.033

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dahm P, Hollingsworth JM (2018) Medical Expulsive Therapy for Ureteral Stones-Stone Age Medicine. JAMA Intern Med 5:6. https://doi.org/10.1001/jamainternmed.2018.2265

    Article  Google Scholar 

Download references

Funding

No funding was received by any of the authors for this study.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA

    Ilir Agalliu

  2. Department of Urology, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA

    Daniel Schoenfeld, Ilir Agalliu & Joshua M. Stern

  3. Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY, 10032, USA

    Larkin Mohn

  4. Department of Urology, Montefiore Medical Center, 1250 Waters Place, Tower 1 Suite 706, Bronx, NY, 10461, USA

    Joshua M. Stern

Authors
  1. Daniel Schoenfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Larkin Mohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ilir Agalliu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joshua M. Stern
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Schoenfeld.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schoenfeld, D., Mohn, L., Agalliu, I. et al. Disparities in care among patients presenting to the emergency department for urinary stone disease. Urolithiasis 48, 217–225 (2020). https://doi.org/10.1007/s00240-019-01136-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-019-01136-y

Keywords

Search

Navigation