Socioeconomic Variations in Pediatric Nephrolithiasis in a Populous Urban County
Arthi Hannallah, MD1, Zoë G. Baker, PhD, MPH1, Shirley Saker, BSc2, Nadine Khouzam, MD1, S. Scott Sparks, MD1.
1Children's Hospital Los Angeles, Los Angeles, CA, USA, 2University of Southern California, Los Angeles, CA, USA.
BACKGROUND: Socioeconomic status (SES) can affect patients’ access to healthcare and overall quality of life. This study sought to determine if SES was associated with body mass index (BMI) and nephrolithiasis-related outcomes in pediatric patients seen in Southern California.
METHODS: This was a retrospective review of pediatric patients with nephrolithiasis from a single tertiary care center based in Los Angeles County. Demographics, home zip codes, and BMI data were reviewed. Median household income (MHI) was assessed with the 2019 American Community Survey 5-Year Estimates. Poverty was defined using the California Poverty Measure (CPM), with near poverty as 1-1.5 times the CPM (Table 1). T-tests and Pearson-X2 tests were used to determine the association between MHI and medical insurance with surgical intervention.
RESULTS: From 2006 to 2021, 348 patients residing in Southern California were seen for nephrolithiasis (Figure 1). MHI was $63,807 (IQR: $49,122-$81,851), and 63.1% of patients were covered under a public-payer health insurance. Over one hundred (31.4%) patients had poverty or near-poverty household incomes (Table 1). Among patients without comorbidities, those with BMIs indicating overweight/obese status were significantly more likely to have lower median household income ($63,926) than patients with healthy BMIs ($72,560, p=0.02). Overweight/obese patients were significantly more likely to be covered by a public insurance plan (72.0%) than patients who had a healthy BMI (58.3%, p=0.04). Patients with poverty or near-poverty household incomes and patients with public health insurance were significantly more likely to undergo surgical intervention than patients with higher incomes (p=0.02; Figure 2) and those with private health insurance coverage (p=0.04).
CONCLUSIONS: Pediatric patients with nephrolithiasis who are at or near-poverty in Southern California are significantly more likely to undergo surgical intervention. Among patients without significant comorbidities, obese and overweight patients had significantly lower median household incomes and were covered under public health insurances at significantly higher rates than patients with healthy weights. Emphasis should be placed on improving access to optimize diet and healthy weight maintenance in pediatric patients with nephrolithiasis, particularly among those who are at or near poverty. 
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