Shin Brandon, Shin David, Siagian Yasmine, Campos Jairo, Wongworawat M Daniel, Baum Marti F
Loma Linda University School of Medicine, Loma Linda, CA, USA.
Surg Open Sci. 2024 Sep 21;21:27-34. doi: 10.1016/j.sopen.2024.09.003. eCollection 2024 Sep.
Access to surgical specialty care differs based on geographic location, insurance status, and subspecialty type. This study uses the Inland Empire as a model to determine the relationship between Social Vulnerability Indices (SVIs), surgeon sex, and surgical subspecialty distribution.
823 census tracts from the Centers for Disease Control's (CDC) SVI 2018 database were compared against 992 surgeons within 30 distinct subspecialties. This data was retrieved from the American Medical Association's (AMA) 2018 Physician Masterfile. Spearman's bivariate and multiple regression were used to compare the relationship between SVI and number of surgical subspecialists within each census tract.
There were approximately 3.34 male and 0.35 female surgeons per census tract ((267) = 7.74, < 0.001). Significant inverse relationships existed between Cosmetic surgery, Urology and Minority status/language (ρ = -0.131 [95 % CI -1.000 to -0.028], = 0.016; ρ = -0.142 [95 % CI -1.000 to -0.039], = 0.010, respectively); General surgery, Socioeconomic status (ρ = -0.118 [95 % CI -1.000 to -0.014], = 0.027), and Household composition/disability (ρ = -0.203 [95 % CI -1.000 to -0.102], < 0.001); Hand surgery and Socioeconomic status (ρ = -0.114 [95 % CI -1.000 to -0.010], = 0.031); Otolaryngology, Housing type/transportation (ρ = -0.102 [95 % CI -1.000 to 0.001], = 0.047), and Overall Social Vulnerability (ρ = -0.105 [95 % CI -1.000 to -0.001], = 0.043). Multiple regression analyses reinforced these findings.
This study concludes that social vulnerability is predictive of, and significantly linked to, differences in distribution of surgical subspecialty and surgeon gender. Future research should investigate recruitment of a diverse surgical workforce, infrastructural barriers to care, and differences in quality of care.
Our work demonstrates complex relationships between surgical subspecialist distribution, surgeon gender, and a census tract's various Social Vulnerability Indices. Thus, this research can serve to continue educating surgeons and other healthcare providers about the importance of social determinants of health in the construction of healthcare policy and practice, as well as incentivizing equitable recruitment of a diverse population of surgeons.
获得外科专科护理的机会因地理位置、保险状况和亚专科类型而异。本研究以内陆帝国为模型，以确定社会脆弱性指数（SVI）、外科医生性别和外科亚专科分布之间的关系。
将疾病控制中心（CDC）2018年SVI数据库中的823个人口普查区与30个不同亚专科的992名外科医生进行比较。这些数据取自美国医学协会（AMA）2018年医生主文件。使用斯皮尔曼双变量和多元回归来比较每个普查区内SVI与外科亚专科医生数量之间的关系。
每个普查区约有3.34名男性外科医生和0.35名女性外科医生（（267）=7.74，<0.001）。整形手术、泌尿外科与少数族裔地位/语言之间存在显著的负相关关系（ρ=-0.131[95%CI-1.000至-0.028]，=0.016；ρ=-0.142[95%CI-1.000至-0.039]，=0.010）；普通外科与社会经济地位（ρ=-0.118[95%CI-1.000至-0.014]，=0.027）以及家庭构成/残疾（ρ=-0.203[95%CI-1.000至-0.102]，<0.001）；手外科与社会经济地位（ρ=-0.114[95%CI-1.000至-0.010]，=0.031）；耳鼻喉科与住房类型/交通（ρ=-0.102[95%CI-1.000至0.001]，=0.047）以及总体社会脆弱性（ρ=-0.105[95%CI-1.000至-0.001]，=0.043）。多元回归分析强化了这些发现。
本研究得出结论，社会脆弱性可预测外科亚专科分布和外科医生性别的差异，并与之显著相关。未来的研究应调查多元化外科劳动力的招募、护理的基础设施障碍以及护理质量的差异。
我们的研究表明，外科亚专科医生分布、外科医生性别与普查区的各种社会脆弱性指数之间存在复杂的关系。因此，本研究有助于继续教育外科医生和其他医疗保健提供者，使其认识到健康的社会决定因素在医疗保健政策和实践构建中的重要性，并激励公平招募多元化的外科医生群体。
