Association of County-Level Social Vulnerability and the Geospatial Distribution of United States Urologists.

Objective: 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.

Methods: This is an ecologic study that uses publicly available datasets on 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.

Results: 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 nearest urologist with the largest effect seen for overall SVI (β=10.85, 95% CI=[8.06, 13.64]).

Conclusions: 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.