PMID- 37247838
OWN - NLM
STAT- MEDLINE
DCOM- 20230829
LR  - 20240210
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Print)
IS  - 0890-5096 (Linking)
VI  - 95
DP  - 2023 Sep
TI  - Defining Vascular Deserts to Describe Access to Care and Identify Sites for 
      Targeted Limb Preservation Outreach.
PG  - 125-132
LID - S0890-5096(23)00283-2 [pii]
LID - 10.1016/j.avsg.2023.05.025 [doi]
AB  - BACKGROUND: Access to care plays a critical role in limb salvage in chronic 
      limb-threatening ischemia (CLTI). A "medical desert" describes a community 
      lacking access to medical necessities, resulting in increased morbidity and 
      mortality. We sought to describe vascular deserts, which we defined as regions 
      with decreased access to specialty care. METHODS: All California providers 
      performing vascular surgery procedures were identified through online provider 
      and health care facility searches. Facility participation in the Society for 
      Vascular Surgery (SVS) Vascular Quality Initiative (VQI) lower extremity bypass 
      (LEB) and peripheral vascular intervention (PVI) modules was also determined. 
      Addresses were geocoded with a 30-mile surrounding buffer using ArcGIS 
      (Geographic information systems), creating maps based on care type, including all 
      providers performing vascular procedures, board-certified vascular surgeons, and 
      facilities participating in VQI modules. Public census data overlayed on the maps 
      demonstrated population composition in desert versus nondesert regions. 
      Subsequently, data from the Healthy Places Index (HPI) was overlayed, providing 
      data regarding 25 social factors, comprising an overall HPI score and percent, 
      with lower scores corresponding to poorer health and outcomes. RESULTS: Maps 
      depicting care regions demonstrated decreased provider coverage with increasing 
      specialty care, with the VQI provider map showing the most prominent "desert" 
      regions. When comparing nondesert versus desert regions by care type, 
      demographics including race, the percentage of the population 200% below the 
      poverty line, and the rate of uninsured residents were described. Social 
      determinants of health were then described for desert and nondesert regions by 
      care type, including the HPI percentage and specific domain factors. The 
      percentage of uninsured residents was significant only in the desert and 
      nondesert areas served by board-certified vascular surgeons (19.6 vs. 16.8%, 
      P < 0.001). The mean HPI percentile was significantly lower in board-certified 
      provider and VQI facility deserts than nondeserts (50.48% vs. 40.65%, P < 0.001 
      and 52.68% vs. 43.12%, P < 0.001, respectively). The economic and education 
      factor percentiles were significantly lower in all desert populations, while the 
      housing, social, and pollution factors were significantly higher in nondesert 
      regions. Health care access, transportation, and neighborhood factor percentiles 
      were significantly lower in board-certified and VQI facility deserts than in the 
      nondesert areas. CONCLUSIONS: Access to vascular care plays a significant role in 
      limb salvage. Through mapping vascular deserts, patient demographics, and social 
      factors in desert regions are better understood, and areas that would benefit 
      most from targeted outreach and limb preservation programs for CLTI are 
      identified.
CI  - Copyright (c) 2023 Elsevier Inc. All rights reserved.
FAU - DiLosa, Kathryn L
AU  - DiLosa KL
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      Davis Health, Sacramento, CA. Electronic address: kldilosa@ucdavis.edu.
FAU - Nguyen, Ryan Khoa
AU  - Nguyen RK
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      Davis Health, Sacramento, CA.
FAU - Brown, Christina
AU  - Brown C
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      Davis Health, Sacramento, CA.
FAU - Waugh, Aidan
AU  - Waugh A
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      Davis Health, Sacramento, CA.
FAU - Humphries, Misty D
AU  - Humphries MD
AD  - Division of Vascular Surgery, Department of Surgery, University of California, 
      Davis Health, Sacramento, CA.
LA  - eng
GR  - K23 HL143178/HL/NHLBI NIH HHS/United States
GR  - T32 HL086350/HL/NHLBI NIH HHS/United States
PT  - Journal Article
DEP - 20230527
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Humans
MH  - Risk Factors
MH  - *Peripheral Arterial Disease/diagnosis/surgery
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/adverse effects
MH  - Limb Salvage
MH  - Health Services Accessibility
MH  - Retrospective Studies
MH  - Ischemia
PMC - PMC10529312
MID - NIHMS1910924
EDAT- 2023/05/30 01:06
MHDA- 2023/08/29 12:43
PMCR- 2024/09/01
CRDT- 2023/05/29 19:24
PHST- 2023/04/04 00:00 [received]
PHST- 2023/05/15 00:00 [revised]
PHST- 2023/05/19 00:00 [accepted]
PHST- 2024/09/01 00:00 [pmc-release]
PHST- 2023/08/29 12:43 [medline]
PHST- 2023/05/30 01:06 [pubmed]
PHST- 2023/05/29 19:24 [entrez]
AID - S0890-5096(23)00283-2 [pii]
AID - 10.1016/j.avsg.2023.05.025 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2023 Sep;95:125-132. doi: 10.1016/j.avsg.2023.05.025. Epub 2023 
      May 27.