(513) Search Trends Signal Increased Vasectomy Interest in States with Sparsity of Urologists After Overrule of Roe vs. Wade
Authors: Patel R , Loloi J , Labagnara K , Watts K 
Published: May 2023

Abstract

Introduction
The Supreme Court of the United States’ (SCOTUS) decision to overrule Roe vs. Wade has rendered abortion illegal across a multitude of states. This decision, which directly impacts the management of women’s reproductive health, may also impact urologic practice.

Objective
Over the last decade, the number of vasectomies performed in the United States has steadily declined across all age groups. With the anticipated lack of reliable access to medical contraception and abortions, we may see a sudden reversal of this trend. Herein, we aim to provide a trend forecast using Google search trends as a surrogate for public interest in vasectomy.

Methods
To establish a baseline and quantify changes in search trends, Google search trends (https://trends.google.com/trends/?geo=US) data from three months prior to and three days after the SCOTUS decision (03/25/2022 – 06/29/2022) were queried for “Vasectomy.” Search trend results are reported using Google’s relative search volume (RSV) metric, which normalizes the data to the time and location of a query. RSV ranges from 0 – 100 and is stratified by state. For each state, we calculated the ratio of licensed Urologists to adult men (ages 18+) using data from the American Urological Association 2021 census and the United States 2020 census. Lastly, we referenced The New York Times to sort states based on legal status of abortion2. States were categorized as either Prohibited (abortion banned or expected to be), Restricted (gestational limit in effect or expected to be), Uncertain (decision based on 2022 ballot), or Legal. Spearman’s correlation was conducted to assess the relationship between RSV and Urologist ratio. ANOVA was used to calculate differences between legal status categories. All analyses were conducted using SPSS Version 27 and statistical significance was set at P-value &lt; 0.05.

Results
We found that RSV was highest in states with the lowest ratio of urologists to adult men (R = -0.36, P=0.017; Table 1). Figure 1 represents the inverse relationship between RSV and urologist-to-adult-men ratio. Following the SCOTUS’ decision, interest in vasectomies was greatest in Oklahoma (RSV = 100), Utah (96), and Idaho (92) and lowest in New York (45), Delaware (47), and New Jersey (50). The ratio of Urologist-to-adult-men (per 100,000) was highest in New York (14.73), Massachusetts (14.20), and New Hampshire (13.52), and lowest in Nevada (7.01), New Mexico (7.33), and Idaho (7.82). ANOVA analysis revealed a significant difference in mean RSV based on legal status of abortion. The difference was greatest between Prohibited states and Legal states (mean RSV 78.5 vs. 64.2, P&lt;0.001).

Conclusions
The field of Urology continues to face a shortage of physicians in the US. This shortage is most palpable in states where recent public interest for vasectomies is highest (and abortion is currently prohibited). The amalgam of high public interest in vasectomies, low urologist-to-adult-male ratio, and abortion prohibition is anticipated to put a strain on the urologic workforce and subsequently increase patient wait times; particularly in areas where the density of Urologists is lowest.

Disclosure
No