Surgery Open Science (Jun 2024)
Analyzing the association between social vulnerability indexes and surgically underserved areas in the Inland Empire
Abstract
Background: The United States lacks equitable surgical access, prompting us to investigate whether there is an inverse relationship between Social Vulnerability Indices and the number of surgeons in a census tract, using the Inland Empire as a model. Methods: The Centers for Disease Control's (CDC) SVI 2018 database, composed of 823 census tracts, was compared against demographics of 1008 surgeons, from the American Medical Association's (AMA) 2018 Physician Masterfile. Analysis was performed via Spearman's bivariate and multiple regression. Results: An inverse relationship exists between surgeon number and overall social vulnerability (ρ = −0.266 [95 % CI −0.330 to −0.199], p < .001), and between surgeon number and each category of social vulnerability: Socioeconomic (ρ = −0.345 [95 % CI −0.0405 to −0.281], p < .001), Household Composition and Disability (ρ = −0.121 [95 % CI −0.190 to −0.051], p < .001), Minority Status and Language (ρ = −0.0317 [95 % CI −0.379 to −0.252], p < .001), and Housing Type and Transportation (ρ = −0.093 [95 % CI −0.153 to −0.023], p = .005). Multiple regression analysis revealed that the following were associated with a higher number of surgeons: higher “Per Capita Income” (B = 0.000151 [95 % CI 0.000079 to 0.000223], t(820) = 4.104, p < .001), larger Daytime Population (B = 0.000143 [95 % CI 0.000072 to 0.000214]; t(820) = 3.956, p < .001), larger Total Population (B = −0.013 [95 % CI −0.022 to −0.003]; t(820) = −2.672, p = .008), and smaller number of Persons aged 17 and younger (B = −0.005 [95 % CI −0.008 to −0.001]; t(820) = −2.794, p = .005). Conclusions: This study concludes that social vulnerability is predictive of, and significantly linked to, differences in surgical access and continues to advocate for research into understanding the surgeon's role in both individual and population health. Key message: Our work demonstrates that the number of surgeons in a census tract is inversely proportional to the census tract's overall Social Vulnerability Indices. Thus, this research can serve to educate the public, physicians, and other healthcare providers about the importance of incorporating social determinants of health into the construction of healthcare policy and practice, as well as the importance of continued funding for local and national social service programs as a means to alleviate specific health inequities, such as language and transportation.
