The association of community-level social vulnerability with access to high-volume endocrine surgeons

Community-level factors have been linked to disparities in access to health care. We examined the relationship between social vulnerability and access to high-volume surgeons.

The Vizient Clinical Database was queried to identify patients who underwent thyroidectomy from 2013 to 2021. Surgeons were classified as low- (1-24 annual cases), medium- (25-49 cases), or high-volume (50+ cases). Regression was used to estimate the probability of operation with a high-volume surgeon based on community-level social vulnerability index scores across nine domains: economic, education, health care, neighborhood, housing, clean environment, social environment, transportation, and public safety. Patient demographics were also analyzed.

Of 375,663 cases, 36.8% were performed by low-volume surgeons, 21.7% by medium-volume surgeons, and 41.5% by high-volume surgeons. Decreased odds of operation with a high-volume surgeon were found among patients residing in communities with higher vulnerability in health care (odds ratio 0.83 [0.82-0.84]), education (odds ratio 0.88 [0.87-0.89]), environmental pollution (odds ratio 0.91 [0.90-0.93]), and public safety (odds ratio 0.95 [0.93-0.97]). Conversely, vulnerabilities in neighborhood resources (odds ratio 1.15 [1.13-1.16]) and transportation (odds ratio 1.07 [1.06-1.09]) were associated with increased access to high-volume care. Males and those without private insurance were less likely to undergo surgery with a high-volume surgeon (odds ratio 0.76 [0.75-0.77] and odds ratio 0.65-0.80, respectively). Patients undergoing operations for malignancy were slightly more likely to see a high-volume surgeon (odds ratio 1.05 [1.04-1.06]).

Patients residing in communities with fewer educational and health care resources were significantly less likely to undergo thyroidectomy with a high-volume surgeon. Policies targeting these domains may yield the greatest community-level impact on patients' access to such care. Individual demographics, however, remain critical determinants of access.