Impact of Social Determinants on Adherence to AUA Cryptorchidism Guidelines: An Ultrasound Study

This multi-institutional study aimed to evaluate the impact of social determinants of health on adherence to the American Urologic Association (AUA) Cryptorchidism Guideline, specifically regarding the use of ultrasound prior to urologic evaluation and the timing of referrals by general practitioners. The study analyzed boys referred for cryptorchidism before and after the establishment of the AUA guidelines, comparing data from 2013, 2015, and 2019. Local indicators of healthcare access—such as median county income, distance to tertiary care centers, and insurance status—were assessed through geocoding patient zip codes. Using univariate generalized linear mixed models, the researchers evaluated the association of these geocoded factors with the likelihood of receiving a pre-evaluation ultrasound and the mean age at referral. A total of 3,243 patients were included in the analysis. Results indicated that boys from rural and designated health shortage areas were more likely to receive pre-evaluation ultrasounds and to be referred to surgeons at a younger age. Specifically, those from these areas had predictive values of 1.38 and 20.5 for undergoing sonography, and a likelihood ratio of 0.87 for earlier referrals. In contrast, boys with private insurance, those living closer to referral centers, and those from wealthier counties were less likely to receive ultrasounds, with predictive values of 0.48, 0.53, and 0.42, respectively. The study concluded that while boys in underserved areas received more timely ultrasounds, overall adherence to the AUA guidelines appeared unaffected by these social determinants of health, highlighting differing drivers of quality care related to resource utilization and referral timing.