Journal Article

State-Level Social Vulnerability Index and Healthcare Access in Patients With Atherosclerotic Cardiovascular Disease (from the BRFSS Survey)

Jain, Vardhmaan, Chen, Yu Han, George, Jerin, Virani, Salim S., Thompson, Zachary M., Al Rifai, Mahmoud, Kayani, Waleed, Kianoush, Sina, Medhekar, Ankit, Khan, Safi U., Patel, Ashley, Petersen, Laura A.

2022

Overview

We analyzed the association between social vulnerability index (SVI) and healthcare access among patients with atherosclerotic cardiovascular disease (ASCVD). Using cross-sectional data from the Behavioral Risk Factor Surveillance System 2016 to 2019, we identified measures related to healthcare access in individuals with ASCVD, which included healthcare coverage, presence of primary care clinician, duration since last routine checkup, delay in access to healthcare, inability to see doctor because of cost, and cost-related medication nonadherence. We analyzed the association of state-level SVI (higher SVI denotes higher social vulnerability) and healthcare access using multivariable-adjusted logistic regression models. The study population comprised 203,347 individuals aged 18 years or older who reported a history of ASCVD. In a multivariable-adjusted analysis, prevalence odds ratios (95% confidence interval) for participants residing in states in the third tertile of SVI compared with those in the first tertile (used as reference) were as follows: absence of healthcare coverage = 1.03 (0.85 to 1.24), absence of primary care clinician = 1.33 (1.12 to 1.58), >1 year since last routine checkup = 1.09 (0.96 to 1.23), delay in access to healthcare = 1.39 (1.18, 1.63), inability to see a doctor because of cost = 1.21 (1.06 to 1.40), and cost-related medication nonadherence = 1.10 (0.83 to 1.47). In conclusion, SVI is associated with healthcare access in those with pre-existing ASCVD. Due to the ability of SVI to simultaneously and holistically capture many of the factors of social determinants of health, SVI can be a useful measure for identifying high-risk populations.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Arteriosclerosis / Atherosclerosis / Cardiovascular disease / Cardiovascular diseases / Chronic illnesses / Confidence intervals / Cost analysis / COVID-19 / Datasets / Disease control / Education / Health care / Hispanic Americans / Medicaid / Mortality / Patients / Physicians / Population / Population studies / Poverty / Primary care / Regression analysis / Regression models / Risk analysis / Risk factors / Rural areas / Social determinants of health / Socioeconomic factors / Statistical analysis / Surveillance systems