Urologic Care Rates Decline Across US Demographics During Height of COVID-19 Pandemic

Daniel J. Lee, MD, MS

The provision of urologic care underwent a significant decline during the height of the COVID-19 pandemic across all demographic groups and practice settings in the United States, regardless of the timing of stay-at-home order mandates, according to findings from a study that were presented during the 36th Annual European Association of Urology (EAU) Congress.

Notably, declines of more than 40% were observed among outpatient visits from March 2020 to April 2020. Although outpatient visits recovered through May 2020 and early June 2020, they began to fall again in July 2020 in the overall population.

“This study provides timely, real-world evidence on the magnitude of decline in the provision of urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses,” Daniel J. Lee, MD, MS, an assistant professor of urologic oncology in the Department of Surgery at the Perelman School of Medicine at the University of Pennsylvania, and co-authors wrote.

Non-urgent visits, including visits for microscopic hematuria, overactive bladder, elevated prostate-specific antigen, erectile dysfunction, and benign prostatic hyperplasia, also declined, as did procedure visits.

Non-urgent visits declined by 39% to 47% from March 2020 to April 2020, whereas visits for urgent diagnoses declined by 29% to 43%. Surgical procedures for non-urgent conditions declined by 37% to 53% compared with surgical procedures for potentially urgent matters, which declined by 13% to 21% during the evaluated time period.

The COVID-19 pandemic affected facets of health care access and delivery, including hospital admissions and outpatient care for certain conditions, throughout the United States, wrote Lee and co-authors. However, the significance of the pandemic with regard to specialty care had not been fully realized, which provided the clinical rationale to conduct the analysis.

The specialty-wide, community-based cohort study evaluated trends in outpatient urologic care visits, as well as procedural volume from February 2020 to July 2020. The study utilized the American Urological Association Quality (AQUA) Registry, which automatically extracts patient data from electronic health records.

AQUA collects data from 157 urology practices, which comprise 3,165 providers. Notably, these providers account for approximately one-fourth of all urologists in the United States, wrote Lee and co-authors. The practices are spread across 48 states and territories in the United States.

The trends were evaluated based on patient, practice, and local or regional demographic and pandemic response features.

Primary outcomes included mean visit volume and procedure volume-per-week, which were compared with the respective weeks in 2019.

Overall, 2,750,001 patients were included in the cohort, which comprised 8,953,832 outpatient visits and 1,570,161 procedures.

The decrease in visits was smaller among African American and Hispanic patients compared with Asian and Caucasian patients; however, African American and Hispanic patients experienced a slower recovery in visits to baseline.

Patients insured by Medicare, most of whom were over the age of 65, observed the steepest reduction in visits at 50%. Additionally, 84.4% of patients insured by Medicaid, most of whom were low-income patients, did not recover to the baseline number of weekly visits before the COVID-19 pandemic.

Finally, among practices located in areas with lower median incomes, higher poverty levels, and lower urologist-to-population rations experienced smaller decreases in outpatient visits.

Reference

1. Lee DJ, Shelton JB, Brendel P, et al. Impact of the COVID-19 pandemic on urologic care delivery in the United States. Presented at: 36th Annual EAU Congress; July 8-12, 2021; Virtual. Abstract P0183.