Social Vulnerability Index as a Tool to Evaluate the Distribution of Head and Neck Oncology Surgeons.

Abstract

Objective: To assess the geographic distribution of head and neck oncology surgeons (HNS) in the U.S. and to evaluate the association of this distribution with neighborhood-level social determinants of health as measured by the Social Vulnerability Index (SVI).

Methods: U.S.-based HNSs and their practice addresses were obtained from publicly available sources. The geographic distribution of HNSs was analyzed at the state, county, and metropolitan statistical area levels. U.S. census tracts were scored on a continuous scale of increasing social vulnerability (0-1) across Overall SVI and four subthemes: Socioeconomic Status, Household Composition-Disability Status, Racial-Ethnic Minority Status, and Housing-Transportation Status. The distance from each census tract to the nearest HNS was calculated, and univariable linear regression analyses assessed associations between SVI scores and distances.

Results: This study included 609 HNSs that were disproportionately distributed at the state, county, and MSA levels. Higher vulnerability scores in Overall SVI (β = 12.9 [95% CI: 11.05, 14.69]), Socioeconomic Status (β = 11.5 [95% CI: 9.67, 13.32]), Household Composition-Disability Status (β = 10.4 [95% CI: 8.61, 12.27]), and Housing-Transportation Status (β = 18.2 [95% CI: 16.42, 20.06]) were associated with significantly increased distance to the nearest HNS, while higher vulnerability scores among Racial-Ethnic Minority Status were associated with significantly decreased distance to the nearest HNS (β = -25.8 [95% CI: -27.64, -24.01]).

Conclusion: Inequities in the distribution of HNSs highlight the need for targeted strategies to improve access to head and neck cancer care. SVI may help identify especially vulnerable areas lacking access to this care.