Davis Ryan J, Park Asher C, Fehrenbach Milan P, Sabharwal Navin, Daneshvar Michael A
Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Northwestern University Feinberg School of Medicine, Chicago, IL.
Urology. 2025 Jul;201:55-61. doi: 10.1016/j.urology.2025.04.046. Epub 2025 Apr 26.
To assesses the relationship between county-level social vulnerability and the distribution of urologists across the United States (US) using the Social Vulnerability Index (SVI), a tool that scores counties based on social determinants of health.
This is an ecologic study that uses publicly available datasets on the number and locations of urologists within the US. The SVI scores counties in terms of their overall social vulnerability and social vulnerability across the following four subthemes: socioeconomic status, race/ethnic minority status, household characteristics, and housing type and transportation. Using these scores, we evaluated associations between county-level social vulnerability and county urologist presence/absence, density, and distance.
Higher county vulnerability in socioeconomic status was significantly associated with higher likelihood of urologist absence (OR = 1.59, 95% CI = [1.20, 2.11]) and lower urologist density (β = -0.65, 95% CI = [-1.18, -0.12]). Similarly, higher vulnerability in household characteristics was associated with higher likelihood of urologist absence (OR = 2.13, 95% CI = [1.61, 2.81]) and lower urologist density (β = -1.51, 95% CI = [-2.03, -0.99]). Higher overall SVI scores and all subtheme scores were significantly associated with increased county miles to the nearest urologist with the largest effect seen for overall SVI (β = 10.85, 95% CI = [8.06, 13.64]).
Using the SVI, we found that counties more socially vulnerable in socioeconomic status and household characteristics have significantly less access to urologists. Our findings suggest that the SVI can be used as a tool to locate socially vulnerable counties lacking access to urologic care and thus could potentially guide policy aimed at advancing equitable urologic access across the US.
使用社会脆弱性指数（SVI）评估美国县级社会脆弱性与泌尿科医生分布之间的关系，SVI是一种根据健康的社会决定因素对各县进行评分的工具。
这是一项生态学研究，使用了美国泌尿科医生数量和位置的公开可用数据集。SVI根据各县的整体社会脆弱性以及以下四个子主题的社会脆弱性对各县进行评分：社会经济地位、种族/少数族裔地位、家庭特征以及住房类型和交通。利用这些分数，我们评估了县级社会脆弱性与县内泌尿科医生的有无、密度和距离之间的关联。
社会经济地位方面较高的县脆弱性与泌尿科医生不在场的可能性较高（OR = 1.59，95% CI = [1.20, 2.11]）以及泌尿科医生密度较低（β = -0.65，95% CI = [-1.18, -0.12]）显著相关。同样，家庭特征方面较高的脆弱性与泌尿科医生不在场的可能性较高（OR = 2.13，95% CI = [1.61, 2.81]）以及泌尿科医生密度较低（β = -1.51，95% CI = [-2.03, -0.99]）相关。较高的整体SVI分数和所有子主题分数与到最近泌尿科医生的县英里数增加显著相关，其中整体SVI的影响最大（β = 10.85，95% CI = [8.06, 13.64]）。
使用SVI，我们发现社会经济地位和家庭特征方面社会脆弱性较高的县获得泌尿科医生服务的机会明显较少。我们的研究结果表明，SVI可作为一种工具，用于定位缺乏泌尿科护理服务的社会脆弱县，从而有可能指导旨在促进美国各地公平获得泌尿科护理服务的政策。
