Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
Am J Prev Med. 2022 Sep;63(3):403-409. doi: 10.1016/j.amepre.2022.03.008. Epub 2022 Apr 30.
Access to health care is affected by social determinants of health. The social vulnerability index encompasses multiple social determinants of health simultaneously and may therefore be associated with healthcare access.
Cross-sectional data were used from the 2016‒2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged ≥18 years. State-level social vulnerability index was derived using county-level social vulnerability index estimates from the Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry. Analyses were performed in October 2021. Social vulnerability index was ranked according to percentiles, which were divided into tertiles: Tertile 1 (0.10-0.32), Tertile 2 (0.33-0.53), and Tertile 3 (0.54-0.90).
In multivariable-adjusted models comparing U.S. states in Tertile 3 with those in Tertile 1 of social vulnerability index, there was a higher prevalence of absence of healthcare coverage (OR=1.39 [95% CI=1.22, 1.58]), absence of primary care provider (OR=1.34 [95% CI=1.22, 1.48]), >1-year duration since last routine checkup (OR=1.18 [95% CI=1.10, 1.27]), inability to see a doctor because of cost (OR=1.38 [95% CI=1.23, 1.54]), and the composite variable of any difficulty in accessing healthcare (OR=1.15 [95% CI=1.08, 1.22]).
State-level social vulnerability is associated with several measures related to healthcare access. These results can help to identify targeted interventions to improve access to health care in U.S. states with high social vulnerability index burden.
卫生保健的可及性受到健康社会决定因素的影响。社会脆弱性指数同时涵盖了多个健康社会决定因素，因此可能与医疗保健的可及性相关。
本研究使用了 2016 年至 2019 年行为风险因素监测系统的横断面数据，这是一项针对美国≥18 岁成年人的全国性电话调查。州级社会脆弱性指数是根据疾病控制与预防中心毒物和疾病登记署的县级社会脆弱性指数估计值计算得出的。分析于 2021 年 10 月进行。社会脆弱性指数根据百分位数进行排名，分为三分位：三分位 1（0.10-0.32）、三分位 2（0.33-0.53）和三分位 3（0.54-0.90）。
在多变量调整模型中，将社会脆弱性指数三分位 3 的美国州与三分位 1 的州进行比较，发现无医疗保险覆盖的患病率较高（OR=1.39 [95%CI=1.22, 1.58]）、无初级保健提供者（OR=1.34 [95%CI=1.22, 1.48]）、上次常规检查后超过 1 年（OR=1.18 [95%CI=1.10, 1.27]）、因费用无法看医生（OR=1.38 [95%CI=1.23, 1.54]）以及任何医疗保健获取困难的综合变量（OR=1.15 [95%CI=1.08, 1.22]）。
州级社会脆弱性与医疗保健获取相关的几个指标有关。这些结果可以帮助确定有针对性的干预措施，以改善社会脆弱性指数负担高的美国州的医疗保健获取。
