Relating economic conditions to vasectomy and vasectomy reversal frequencies: a multi-institutional study

Temporal trend of vasectomies in Brazil and its regions by age group and race/skin color: a temporal analysis from 2013 to 2022

OBJECTIVE

To analyze the temporal trend of vasectomies in Brazil and its regions by age group and race/skin color from 2013 to 2022.

METHODS

This is a time series analysis study based on Hospital Information System data. Average annual percentage change (AAPC) and 95% confidence intervals (95%CI) of vasectomy coefficients were estimated using Joinpoint regression. Trends were compared using parallel testing and coincidence testing.

RESULTS

In the period, there were 309,047 vasectomies in Brazil and their trend was stationary (AAPC 5.57; 95%CI -1.08; 12.66), although there was a rising trend in the Northern region (AAPC 11.53; 95%CI 2.30; 21.59) and in the Northeast region (AAPC 8.90; 95%CI 1.94; 16.34). All races/skin colors showed rising trends. Men who were 50-54 years old (AAPC 8.69; 95%CI 1.14; 16.81) and 55-59 years old (AAPC 8.71; 95%CI 0.92; 17.10) had the highest AAPC as well as rising trends. There were differences in trends, especially between age groups.

CONCLUSION

Vasectomy trends varied across Brazil, highlighting regional, age and racial disparities related to this procedure.

Patient perspectives on vasectomy: findings from a TikTok® content analysis

Social media is increasingly used as a platform for patients to explore health care information. Our objective was to study the content on TikTok® in order to gain insight into the perspectives shared by the public on vasectomy. A search was performed using the hashtag ´#vasectomy´ on 12.20.2023 and the top 100 video posts from persons self-identifying as patients were included. Using an adaptation of a previously published system, a framework was created for organising and categorising the data related to vasectomy. Domains covered included reason for vasectomy, complications, vasectomy as a controversial topic in society and reference to the 2022 Dobbs v. Jackson ruling. Most content originated from the United States (85.0%) and the median number of views per video was 261 200 (interquartile range (IQR) 8416-1 800 000). In 12.0% of posts, the individual clearly stated that they were under 30 years of age. Two of the commonest topics to be addressed in the videos were recovery (41.0%) and pain (40.0%). 30.0% discussed the reason for undergoing vasectomy. Reasons included women's rights (12%), safety over tubal ligation (5.0%) and desire to be childless (4.0%). 9.0% referred to the Dobbs v. Jackson ruling. Complications were discussed in 19.0% including vasectomy failure (12.0%). 23.0% contained factually incorrect medical information. 31.0% of videos included the user voicing that vasectomy was considered to be a controversial subject. More than half of the videos (61.0%) were positive regarding the vasectomy process. Our findings reveal that vasectomy receives very high engagement on social media. This study confirms that patients do use it to share their experiences, both positive and negative. Misconceptions regarding this contraception method are common among the public and the urological community should work to address this.

Inflation and health: a global scoping review

High levels of economic inflation can adversely affect societies and individuals in many ways. Although numerous studies explore the health implications of macroeconomic factors, systematic investigation of the inflation-health nexus has been scarce. We conducted a comprehensive scoping review mapping the literature on inflation and health. From 8923 screened records, 69 empirical studies were analysed. These studies explored a wide range of health-related risk factors (eg, diet, substance use, stress, and violence) and outcomes (eg, life expectancy, mortality, suicidal behaviour, and mental health) linked to inflation, across diverse contexts and timeframes. The findings suggest a predominantly negative effect of inflation on health, with specific socioeconomic groups facing greater risks. Our Review uncovers notable gaps in the literature, particularly in geographical coverage, methodological approaches, and specific health outcomes. Among global socioeconomic and geopolitical shifts, understanding and mitigating the health effects of inflation is of contemporary relevance and merits thorough academic attention.

Trends in the Vasectomy Rate Among Privately Insured Men Aged 18-64 in the United States Between 2014 and 2021

OBJECTIVE

To update trends in the vasectomy rate among privately insured men aged 18-64 in the United States (U.S.) between 2014 and 2021.

MATERIALS AND METHODS

We used commercial health insurance claims data between 2014 and 2021 to calculate the annual vasectomy rate in men aged 18-64 in the U.S. We performed these calculations nationally and by age group, marital status, maternal age of a wife, number of children, U.S. Census Bureau region, geography, geographical region, and state. We calculated the absolute and relative changes in these rates from 2014 to 2021 to study how much and how quickly they changed.

RESULTS

The vasectomy rate among privately insured men aged 18-64 in the U.S. increased by 0.11%-a 26% change-from 2014 (0.427%) to 2021 (0.537%). The absolute changes were greatest in men with 3 or more children (0.489%), with 2 children (0.295%), with a wife not of advanced maternal age (0.276%), and aged 35-44 (0.243%). The relative changes were greatest in men with no children (61%), with a wife of advanced maternal age (40.8%), who were single (40.6%), and aged 18-24 (36.7%). In every region except the Northeast, the absolute and relative changes were greater in rural geographies compared to urban geographies.

CONCLUSIONS

The vasectomy rate among privately insured men aged 18-64 in the U.S. increased between 2014 and 2021. Further investigation is needed to ensure demand for vasectomies may continue to be met.

Vasectomy: is the apparent decline real or not?

Trends in vasectomy use are controversial, but rates might be declining over time. Several factors could contribute to this apparent decrease, which warrant consideration before definitive conclusions are made.

Vasectomy utilization in men aged 18-45 declined between 2002-2017: Results from the United States National Survey for Family Growth Data

BACKGROUND

Vasectomy remains a safe, simple and effective contraceptive options. Conflicting data on the trend of vasectomy use among men have been described previously at various snapshots in time over the last two decades.

OBJECTIVES

This paper seeks to describe the trend of vasectomy utilization in the last 15 years using a nationally representative United States survey.

MATERIALS AND METHODS

We analyzed data from male respondents aged 18 to 45 years of the Cycle 6 (2002), 2006-2010, 2011-2013, 2013-2015, and 2015-2017 National Survey of Family Growth (NSFG) surveys. Population estimates are calculated based on the official NSFG instructions, accounting for the complex survey design. Multivariate logistic regression models are used to study demographic and socioeconomic factors associated with vasectomy use in men.

RESULTS

Baseline characteristics for men undergoing vasectomy do not differ significantly across survey years. Increased age, White race, marital status, higher education level, birthplace within the United States, higher household income, non-Catholic affiliation, and higher number of biological kids have significant positive associations with vasectomy use. After accounting for factors associated with vasectomy utilization, there was a significant temporal decline in vasectomy utilization rates in all age groups across survey years which remained in subgroup analyses of all men greater than 25, 30, and 35 of age.

DISCUSSION

This is the first population-based analysis of US data to observe a decline in vasectomy utilization over the past two decades. The decline was statistically significant after accounting for all demographic and socioeconomic factors.

CONCLUSION

There is a steady decline in the prevalence of vasectomy use in men from 2002 to 2017. Given the limited contraceptive options for men and the importance of contraception and family planning in the US, further research is needed to understand the temporal decline. This article is protected by copyright. All rights reserved.

Impact of Economic Downturn on the Surgical Volumes of Common Hand Procedures

BACKGROUND

Economic conditions affect surgical volumes, particularly for elective procedures. In this study, the authors aimed to identify the effects of the 2008 U.S. economic downturn on hand surgery volumes to guide surgeons and managers when facing future economic crises.

METHODS

The authors used the California State Ambulatory Surgery and Services Database from January of 2005 to December of 2011, which includes the entire period of the Great Recession (December of 2007 to June of 2009). The authors abstracted the monthly volume of five common hand procedures using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes. Pearson statistics were used to identify the correlation between unemployment rate and surgical volume for each procedure.

RESULTS

The total number of operative cases was 345,583 during the 7-year study period. Most common elective hand procedures, such as carpal tunnel release and trigger finger release, had a negative correlation with unemployment rate, but the volume of distal radius fracture surgery did not show any correlation. Compared with carpal tunnel release (r = -0.88) or trigger finger release volumes (r = -0.85), thumb arthroplasty/arthrodesis volumes (r = -0.45) showed only a moderate correlation.

CONCLUSIONS

The economic downturn decreased elective hand procedure surgical volumes. This may be detrimental to small surgical practices that rely on revenue from elective procedures. Taking advantage of the principle that increased volume reduces unit cost may mitigate the lost revenue from these elective procedures. In addition, consolidating hand surgery services at larger, regional centers may reduce the effect of the economic environment on individual hand surgeons.

The Crush Index: Orthopedic Trauma as an Economic Indicator

The purpose of this study was to evaluate the relationship between economic activity and the incidence of high-energy orthopedic trauma. California's Office of Statewide Health Planning and Development patient discharge database was queried to identify monthly orthopedic trauma incidence from 1995 to 2010. Patient inclusion required 1 diagnosis code and 1 associated procedural code for fractures of the femur, tibia, ankle, pelvis, or acetabulum. Data on composite market indices, energy and transportation use, and unemployment were obtained from government sources. Statistical analysis was performed using univariate and multivariate linear regression. The average monthly incidence of orthopedic trauma was 2.92 cases per 100,000 people. Of 15 economic indicators analyzed with univariate regression, 7 variables correlated with trauma incidence to statistical significance. Dow Jones Industrial Average (P=.032), Standard & Poor's 500 (P=.034), vehicle miles driven (P<.001), personal disposable income (P=.033), Coincident Economic Activity Index for California (P=.007), and vehicles purchased (P<.001) were positively correlated with trauma incidence. Unemployment (P<.001) was inversely correlated with trauma incidence. Multivariate regression was used to compute a combination of independent predictors of trauma volume: personal disposable income (P<.001), vehicles purchased (P=.008), and unemployment (P=.005). This combination of variables was used to develop the Crush Index to model the relationship between economic activity and orthopedic trauma volume. The authors show a positive correlation between economic strength and activity and the monthly volume of high-energy orthopedic trauma. The Crush Index serves as a proof of concept that may be useful in guiding preparedness among practitioners and health care system administrators. [Orthopedics. 2017; 40(4):248-255.].