INTRODUCTION: Socioeconomic disparities significantly influence healthcare access and patient outcomes. The Area Deprivation Index (ADI) is a validated measure of socioeconomic status based on income, education, employment, and housing quality, derived from a patient’s nine-digit ZIP code. Travel time to healthcare services is another known barrier to care. Prior studies have shown that limited geographic access may contribute to disparities in urogynecologic care. This study aimed to stratify travel distance to urogynecology services by ADI to assess how socioeconomic status relates to geographic access. OBJECTIVE: To assess whether ADI scores were associated with driving times, distances to urogynecology visits, and time to surgery from initial consult. Secondary outcomes included primary care provider referral rates, driving time and distance to primary care visits, and surgical complication rates. METHODS: This study was a retrospective chart review of 484 patients for whom a surgical booking request for urogynecology surgery was placed during two time periods (February 1, 2023, to July 31, 2023, and February 1, 2024, to July 31, 2024). Demographics, home address, driving distances and times (to urogynecology clinic, primary care provider (PCP) clinic, and hospital where surgery was performed), PCP referral rates and indications for referral, and medical perioperative complications were collected by manual extraction. Each patient was assigned a national ADI percentile based on their nine-digit zip code. National percentiles are ranked 1−100, with the 100th percentile representing the most disadvantaged group. Patients were separated into three groups based on percentile (Group 1, least disadvantaged: 0−25% (n=86); Group 2: 26−75% (n=364); Group 3, most disadvantaged: 76−100% (n=34)). Statistical analyses included Kruskal−Wallis tests for continuous variables and chi-square, Fisher’s Exact, or Monte Carlo estimation for categorical variables. RESULTS: The median age was 61.5 years; 95% of patients were White, 97.3% spoke English as their primary language, and 48.8% had government insurance. These demographics were similar across ADI groups (Table 1). Driving time and distance to both the urogynecology clinic and hospital were significantly greater for patients in the most disadvantaged group (Group 3) (p<0.001). Average driving time to the urogynecology clinic was 35 minutes for Groups 1 and 2, compared to 85 minutes for Group 3. Hospital driving times averaged 28 minutes (Group 1), 35 minutes (Group 2), and 90 minutes (Group 3) (p<0.001). There were no significant differences across ADI groups in driving time to PCP visits, PCP referral rates, or medical complication rates. The median time from initial consultation to surgery was 92 days, with no significant variation by ADI group. The overall percentage of delayed surgeries was 10.9% and overall percentage of canceled surgeries was 13.8%. The number of canceled and delayed surgeries did not vary by ADI group (Table 2). CONCLUSIONS: Patients from more socioeconomically disadvantaged areas had significantly longer travel times and distances to both urogynecology clinics and surgical hospitals. These geographic barriers did not translate into delays in surgical care or increased rates of surgery cancellation or complications. However, the overall medical complication rate was very low.Table 1Table 2
Tamkus et al. (Fri,) studied this question.