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Evaluation Of Health Salience And Social Vulnerabilities Among Outpatient Vascular Surgery Patients
Tyler Lackland, Medical Student.
Saint Louis University School of Medicine, St. Louis, MO, USA.
INTRODUCTION: Social determinants of health including social vulnerabilities may impact a patient's ability to maintain generalized health and wellness. Health salience (HS) is a newly defined social vulnerability variable that focuses on how a patient prioritizes their health regarding other life factors. The purpose of this study is to study HS in an outpatient vascular surgery setting and understand factors predictive of low health salience.
METHODS: Over a four-week period, we surveyed vascular surgery patients seen in the outpatient clinics of a tertiary medical center. Validated scales used were the Health Salience Questionnaire, Social Vulnerabilities Survey and the Modified Frailty Index. Patient factors were identified by chart review. Univariate analysis was performed to identify factors associated with HS.
RESULTS: 118/348 (33%) patients completed the survey of which sixty (51.3%) were male, 113 (96.6%) were US born, and 71 (60.7%) were white with a mean age of 59.6 years. 69 (59%) believed they were in good/excellent health. Health salience was categorized as either low or high . High health salience scores was more significant among those born in the US (0.05), identified as Caucasian/White American (0.04), and believed they are in good/excellent health (0.04). Gender, educational status, social vulnerability factors (transportation, social support, financial barriers, healthcare belief and use) and frailty were not associated with HS.
CONCLUSIONS: Health salience in vascular surgery patients may be associated with country of birth and ethnicity. Further study is necessary to identify modifiable factors associated with this important social vulnerability variable as well as its association with outcomes in this patient population.
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| Table 1 | Total | High Salience | Low Salience | p-value |
| Age | 59.4 (14.7) | 57.5 (16.4) | 61.4 (12.5) | 0.079 |
| Gender - Male | 60 (51.3%) | 28 (46.7%) | 32 (56.1%) | 0.305 |
| US born | 113 (96.6%) | 56 (93.3%) | 57 (100%) | 0.047 |
| Married | 42 (35.9%) | 22 (36.7%) | 20 (35.1%) | 0.859 |
| White | 71 (60.7%) | 31 (51.7%) | 40 (70.2%) | 0.04 |
| Education beyond HS | 62 (53.0) | 33 (55.0%) | 29 (50.9%) | 0.655 |
| Income | | | | |
| <25k | 46 (39.3%) | 25 (41.7%) | 21 (36.8%) | 0.953 |
| 25-100k | 48 (41.0%) | 24 (40.0%) | 24 (42.1%) | |
| >100k | 8 (6.8%) | 4 (6.7%) | 4 (7.0%) | |
| not reported | 15 (12.8%) | 7 (11.7%) | 8 (14.0%) | |
| # Dependents | 1.86 (±1.05) | 1.91 (±1.15) | 1.81 (±0.95) | 0.318 |
| Walk without assistance | 70 (59.8%) | 36 (60.0%) | 34 (59.7%) | 0.969 |
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| Believe Good/excellent health | 69 (59.0%) | 41 (68.3%) | 28 (49.1%) | 0.035 |
| Has a PCP | 108 (92.3%) | 54 (90.0%) | 54 (94.7%) | 0.337 |
| Time to Family Doc | 20.5 (±16.5) | 21.8 (±16.8) | 19.2 (±16.22) | 0.217 |
| Time to Walk-in clinic | 17.1 (±14.7) | 16.9 (±15.8) | 17.3 (±13.6) | 0.455 |
| Salience Score | 0.593 (±0.119) | 0.677 (±0.082) | 0.505 (±0.082) | |
| Diabetes Melitus Type 2 | 41 (35.0%) | 22 (36.7%) | 19 (33.3%) | 0.706 |
| Hypertension | 77 (65.8%) | 37 (61.7%) | 40 (70.2%) | 0.332 |
| Congestive Heart Failure | 20 (17.1%) | 11 (18.3%) | 9 (15.8%) | 0.715 |
| Myocardial Infarction | 13 (11.1%) | 10 (16.7%) | 3 (5.26%) | 0.05 |
| Peripheral Vascular Disease | 40 (34.2%) | 24 (40.0%) | 16 (28.1%) | 0.174 |
| Cardiac Problems | 8 (6.8%) | 5 (8.3%) | 3 (5.3%) | 0.511 |
| Lung Problems | 16 (13.7%) | 8 (13.3%) | 8 (14.0%) | 0.912 |
| Transient Ischemic Attack | 3 (2.6%) | 0 (0%) | 3 (5.3%) | 0.072 |
| Stroke with deficit | 12 (10.3%) | 6 (10.0%) | 6 (10.5%) | 0.925 |
| Social Vulnerability Index Score | | | | |
| High Home Score | 28 (23.9%) | 15 (25.0%) | 13 (22.8%) | 0.781 |
| High Financial Score | 10 (8.55%) | 6 (10.0%) | 4 (7.0%) | 0.564 |
| High Transport Score | 106 (90.6%) | 52 (86.7%) | 54 (94.7%) | 0.135 |
| High Social Score | 69 (59.0%) | 39 (65.0%) | 30 (52.6%) | 0.174 |
| High Health Score | 96 (82.1%) | 50 (83.3%) | 46 (80.7%) | 0.711 |
| Modified Fragility Index | 63 (53.9%) | 33 (55.0%) | 30 (52.6%) | 0.797 |
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