title: Factors Associated with Compliance in Submitting 24-Hour Urine Collections in an Underserved Community.
abstract: Patients living in underserved areas do regularly express an interest in stone prevention; however, factors limiting participation, aside from obvious cost considerations, are largely unknown. To better understand factors associated with compliance with submitting 24-hour urine collections, we reviewed our patient experience at the kidney stone clinic at a hospital that provides care for an underserved urban community.
  
  
  
  A retrospective chart review of patients treated for kidney and/or ureteral stones between August 2014 and May 2016 was performed. Patient demographics, medical characteristics, stone factors, and compliance data were compiled into our data set. Patients were divided into two groups: those who did and did not submit the requested initial 24-hour urine collection. Analysis of factors related to compliance was performed using univariate analysis and multivariate logistic regression.
  
  
  
  A total of 193 patients met inclusion criteria for our study, 42.5% (82/193) of whom submitted 24-hour urine samples. Of the 82 collections submitted, 34.1% (28/82) were considered inadequate by creatinine level. A second urine collection within 6 months was obtained in 14.0% (27/193) of patients. Univariate analysis demonstrated that African American (AA) patients were less likely to submit an initial 24-hour urine collection than Caucasian patients (collected: 30.9% vs 51.8%; p < 0.05, respectively). Patients with a family history of kidney stones were more likely to submit an initial 24-hour urine collection than patients without a family history of kidney stones (61.1% vs 38.2%, p < 0.02, respectively). On multivariate analysis, both factors remained significant predictors of compliance with submitting a 24-hour urine collection.
  
  
  
  In our underserved patient population, AA patients were half as likely to submit a 24-hour urine collection than Caucasian patients, whereas patients with a positive family history of stones were more than twice as likely to submit than patients with no family history.
authors.affiliation: 1 Department of Urology, Einstein Healthcare Network , Philadelphia, Pennsylvania.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Ghiraldi
authors.affiliation: 1 Department of Urology, Einstein Healthcare Network , Philadelphia, Pennsylvania.
authors.forename: Madhumitha
authors.initials: M
authors.lastname: Reddy
authors.affiliation: 2 Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center , Philadelphia, Pennsylvania.
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.affiliation: 3 Philadelphia College of Osteopathic Medicine , Philadelphia, Pennsylvania.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Lawler
authors.affiliation: 1 Department of Urology, Einstein Healthcare Network , Philadelphia, Pennsylvania.|4 Division of Urologic Oncology and Urology, Fox Chase Cancer Center , Philadelphia, Pennsylvania.
authors.forename: Justin I
authors.initials: JI
authors.lastname: Friedlander
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005190:Family; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000652:urine*; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population / Q000706:statistics & numerical data*; D014514:Ureteral Calculi / Q000652:urine*; D059349:Urine Specimen Collection / Q000706:statistics & numerical data*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: compliance; metabolic evaluation; nephrolithiasis; underserved population