Association of Unmet Social Needs With Missed In-Person Urology Clinic Appointments

Introduction: Social determinants of health (SDH) are nonbiologic influencers of disease and health care disparities. This study focused on understanding the association between SDH and urology clinic “no-show” visits within a diverse urban population. Methods: We retrospectively identified patients scheduled for urology clinic visits from October 2015 to June 2022 who completed a 10-question social needs screener. For each patient, demographic variables, and number of missed clinic appointments were abstracted. Multivariable logistic regression was performed to determine the association of unmet social needs and no-shows. Results: Of 5761 unique patients seen in clinic, 5293 completed a social needs screener. Respondents were most commonly male (62.8%), Hispanic (50.3%), English-speaking (75.5%), and insured by Medicare (46.0%). Overall, 8.2%, 4.6%, and 6.1% reported 1, 2, and 3þ unmet social needs, respectively. Most patients (61.7%) had 0 no-shows; 38.3% had 1þ no-shows. Between the 0 and 1þ no-show groups, we found significant differences with respect to gender (P ¼.05), race/ethnicity (P ¼ .002), preferred language (P ¼ .006), insurance payer (P < .001), SDH status (P ¼ .003), and total number of unmet social needs (P ¼ .006). On multivariable analysis, patients concerned about housing quality (odds ratio [OR] ¼ 1.50, P ¼ .002), legal help (OR ¼ 1.53, P ¼ .009), and with 3þ unmet social needs (OR ¼ 1.39, P ¼ .006) were more likely to have 1þ no-shows. Conclusions: Unmet social needs were associated with increased no-show urology clinic visits. Routine social needs screening could identify at-risk patients who would benefit from services. This may be particularly pertinent for patients with urgent diagnoses or those requiring frequent office visits where missing appointments could impact morbidity and mortality.