Socioeconomic and racial disparities are well-established determinants of health outcomes, yet their influence on male reproductive health remains underexplored. Semen quality, particularly total motile sperm count (TMSC), is increasingly recognized not only as a marker of fertility but also as a proxy for overall health. This study investigates the relationship between neighborhood-level socioeconomic deprivation and racial composition with semen quality among men undergoing fertility evaluation. To assess the association between neighborhood deprivation, measured by the Area Deprivation Index (ADI), and TMSC, and to evaluate racial disparities in these associations. A retrospective cohort study was conducted involving 2,198 men evaluated at a single academic fertility clinic in Georgia between 2015 and 2024. ADI scores were calculated using geocoded residential addresses and matched to census block data. Participants were stratified into quartiles based on ADI scores. Semen samples were analyzed for TMSC and other parameters. Regression analyses were performed to assess associations between ADI, race, and semen quality. The mean ADI score was 67.1 ± 19.9, and the mean TMSC was 71.3 million. A statistically significant inverse relationship was found between ADI and TMSC (B = -0.403, p < .001), indicating a decrease of approximately 4 million motile sperm per 10-point increase in ADI. Black men had the highest ADI scores and were disproportionately represented in the most deprived quartile, which was associated with the lowest TMSC. In contrast, White and Asian/Hispanic men were more likely to reside in less deprived neighborhoods and exhibited higher sperm counts. Neighborhood socioeconomic deprivation is significantly associated with reduced semen quality, with Black men disproportionately affected. These findings underscore the impact of structural inequality on male reproductive health and suggest that socioeconomic context should be considered in fertility assessments. Addressing neighborhood-level disparities may improve reproductive outcomes and reduce health inequities. Clinicians should incorporate socioeconomic factors into infertility evaluations and consider targeted interventions for men from disadvantaged neighborhoods. Public health policies aimed at improving environmental conditions, healthcare access, and lifestyle resources in deprived areas may mitigate adverse effects on male fertility.
Pridgen et al. (Sun,) studied this question.