title: Relating economic conditions to vasectomy and vasectomy reversal frequencies: a multi-institutional study.
abstract: OBJECTIVE
  It was theorized that the use of permanent contraceptive methods may vary with economic conditions. We evaluated the relationship between vasectomy/vasectomy reversal frequencies at several large referral centers and national economic indicators during 2 recessions spanning 2001 to 2011.
  
  
  METHODS
  We performed an institutional review board approved, retrospective chart review to identify the number of vasectomies/vasectomy reversals per month at several large referral centers from January 2001 to July 2011. The rates of these procedures were pooled, correlated with national economic data and analyzed in a multivariate linear regression model.
  
  
  RESULTS
  A total of 4,599 vasectomies and 1,549 vasectomy reversals were performed at our institutions during the study period. The number of vasectomies per month positively correlated with the unemployment rate (r=0.556, p<0.001) and personal income per capita (r=0.276, p=0.002). The number of reversals per month negatively correlated with the unemployment rate (r=-0.399, p<0.001) and personal income per capita (r=-0.305, p<0.001). Neither vasectomy nor vasectomy reversal frequency significantly correlated with the inflation rate or the S&P 500®. Regression models confirmed that the unemployment rate explained more of the variance in vasectomy/vasectomy reversal frequencies than other indicators.
  
  
  CONCLUSIONS
  We noted a correlation between the number of vasectomies/vasectomy reversals performed at our institutions and national economic indicators. The strongest association was with the unemployment rate. This points to the importance of financial pressure on family planning decisions.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Vidit
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Sherwin
authors.initials: S
authors.lastname: Zargaroff
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Kunj R
authors.initials: KR
authors.lastname: Sheth
authors.affiliation: Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Brian V
authors.initials: BV
authors.lastname: Le
authors.affiliation: Department of Urology, Baylor College of Medicine, Houston, Texas.
authors.forename: James M
authors.initials: JM
authors.lastname: Dupree
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jay I
authors.initials: JI
authors.lastname: Sandlow
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland, Oregon.
authors.forename: A Scott
authors.initials: AS
authors.lastname: Polackwich
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Hedges
authors.affiliation: Department of Urology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Fuchs
authors.affiliation: Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University and Center for Biomedical Research, the Population Council, New York, New York.
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: r-brannigan@northwestern.edu.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Brannigan
mesh_terms: D003365:Costs and Cost Analysis; D004651:Employment / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D007182:Income / Q000639:trends*; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States; D014659:Vasectomy / Q000191:economics*; D014669:Vasovasostomy / Q000191:economics*
keywords: income; testis; unemployment; vasectomy; vasovasostomy