产前肾积水泌尿科会诊：真正的公平还是隐藏的差距？

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-26 DOI:10.1016/j.jss.2025.03.009

Aiden Hoefer BS , Meridiana Mendez BS , Gemima Nanizao BS candidate , Kathleen Kieran MD, MS, MME

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引用次数: 0

摘要

产前泌尿科咨询（PUC）现在提供给许多准父母胎儿产前肾积水（PH）。本研究旨在描述患者和社区在PH患者产前和产后泌尿系统护理模式方面的差异，并确定可能改变的因素，以改善及时获得护理。方法选取2021年1月至2022年12月在一家独立儿童医院就诊的所有年龄≥6岁的PH患者。收集患者性别、种族/民族、上尿路扩张特征、分娩时间和社会经济地位的数据。比较合并PUC和未合并PUC的患者。结果250例患者符合纳入标准。其中男性179例（71.6%），白人122例（48.8%），PUC 56例（22.4%）。患有PUC的患者比未患有PUC的患者更早进行产后评估（0.62[0.2-5.0]对2.1[0.1-12.8]个月）(P <；0.0001)，但患双侧PH的可能性相同（41.1%对41.2%,P = 0.73）。患者会说英语(54/229；23.6%)和其他语言(爱；2/21;9.5%)患PUC的可能性相等。生活在最不贫困地区（区域剥夺指数[ADI]， 1-2）和中等贫困地区（ADI, 3-8）的儿童数量相等(优势比[OR] = 1.52；95%置信区间[CI]: 0.55-4.23)和三次(OR = 2.99；95% CI: 1.16-7.67)与生活在最贫困地区的人（ADI, 9-10）一样可能患有PUC。在早产儿中，生活在ADI 1-2的早产儿中有25%患有PUC，而生活在ADI 9-10的早产儿中有0% (OR = 3.32；95% CI, 0.57-11.4)， 24%的英语患者患有PUC，而LOE患者为0% (OR = 1.98；95% ci, 0.09-45.6)。生活在ADI 1-2的双侧PH患者发生PUC的可能性相似(6/33；18.2%)和ADI 9-10 (2/19；10.5%;OR = 1.89 [95% CI, 0.34-10.45])和说英语的人(23/96；24%)和LOE (0/7；0%;Or = 4.80 [95% ci, 0.26-87.2])。结论spuc与出生后早期泌尿系统评估有关，但在我们的研究中，与PH偏侧、语言、种族或最低水平的邻里不利因素无关。然而，在某些亚组中，有和没有PUC的比例明显较低。对PUC使用率低的患者群体的进一步研究可能会确定患者和社区层面的因素与不同的护理机会相关。

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Prenatal Urologic Consultation for Prenatal Hydronephrosis: True Equity or Hidden Disparity?

Introduction

Prenatal urologic consultation (PUC) is now offered to many prospective parents for fetal prenatal hydronephrosis (PH). This study aims to describe patient- and community-level differences in prenatal and postnatal urologic care patterns for patients with PH and to identify potentially modifiable factors that would improve timely access to care.

Methods

We identified all patients with PH aged <6 mos seen at a single freestanding children’s hospital from January 2021 to December 2022. Data were collected on patient gender, race/ethnicity, characteristics of upper tract dilatation, timing of delivery, and socioeconomic status. Patients with and without PUC were compared.

Results

Two hundred and fifty patients met inclusion criteria. One hundred seventy-nine (71.6%) were male, 122 (48.8%) were White, and 56 (22.4%) had PUC. Patients with PUC had postnatal evaluation earlier than those without PUC (0.62 [0.2-5.0] versus 2.1 [0.1-12.8] months (P < 0.0001) but were equally likely to have bilateral PH (41.1% versus 41.2%, P = 0.73). Patients speaking English (54/229; 23.6%) and other languages (LOE; 2/21; 9.5%) were equally likely to have PUC. Children living in the least (Area Deprivation Index [ADI], 1-2) and moderately disadvantaged areas (ADI, 3-8) were equally (odds ratio [OR] = 1.52; 95% confidence interval [CI]: 0.55-4.23) and three times (OR = 2.99; 95% CI: 1.16-7.67) as likely to have PUC as those living in the most disadvantaged areas (ADI, 9-10), respectively. Of preterm infants, 25% of those living in ADI 1-2 had PUC, compared with 0% of those living in ADI 9-10 (OR = 3.32; 95% CI, 0.57-11.4), and 24% of those speaking English had PUC, compared with 0% of those with LOE (OR = 1.98; 95% CI, 0.09-45.6). The likelihood of PUC for patients with bilateral PH was similar for patients living in ADI 1-2 (6/33; 18.2%) and ADI 9-10 (2/19; 10.5%; OR = 1.89 [95% CI, 0.34-10.45]) and for those speaking English (23/96; 24%) and LOE (0/7; 0%; OR = 4.80 [95% CI, 0.26-87.2]).

Conclusions

PUC is associated with earlier postnatal urologic evaluation, but—in our series—not with PH laterality, language, race, or lowest levels of neighborhood disadvantage. However, the proportion with and without PUC in certain subgroups was notably low. Further research centering on patient groups with low PUC utilization may identify patient- and community-level factors associated with differential access to care.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.