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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.

Table 1 TotalHigh SalienceLow Saliencep-value
Age59.4 (14.7)57.5 (16.4)61.4 (12.5)0.079
Gender - Male60 (51.3%)28 (46.7%)32 (56.1%)0.305
US born113 (96.6%)56 (93.3%)57 (100%)0.047
Married42 (35.9%)22 (36.7%)20 (35.1%)0.859
White71 (60.7%)31 (51.7%)40 (70.2%)0.04
Education beyond HS62 (53.0)33 (55.0%)29 (50.9%)0.655
Income
<25k46 (39.3%)25 (41.7%)21 (36.8%)0.953
25-100k48 (41.0%)24 (40.0%)24 (42.1%)
>100k8 (6.8%)4 (6.7%)4 (7.0%)
not reported15 (12.8%)7 (11.7%)8 (14.0%)
# Dependents1.86 (1.05)1.91 (1.15)1.81 (0.95)0.318
Walk without assistance70 (59.8%)36 (60.0%)34 (59.7%)0.969

Believe Good/excellent health69 (59.0%)41 (68.3%)28 (49.1%)0.035
Has a PCP108 (92.3%)54 (90.0%)54 (94.7%)0.337
Time to Family Doc20.5 (16.5)21.8 (16.8)19.2 (16.22)0.217
Time to Walk-in clinic17.1 (14.7)16.9 (15.8)17.3 (13.6)0.455
Salience Score0.593 (0.119)0.677 (0.082)0.505 (0.082)
Diabetes Melitus Type 241 (35.0%)22 (36.7%)19 (33.3%)0.706
Hypertension77 (65.8%)37 (61.7%)40 (70.2%)0.332
Congestive Heart Failure20 (17.1%)11 (18.3%)9 (15.8%)0.715
Myocardial Infarction13 (11.1%)10 (16.7%)3 (5.26%)0.05
Peripheral Vascular Disease40 (34.2%)24 (40.0%)16 (28.1%)0.174
Cardiac Problems8 (6.8%)5 (8.3%)3 (5.3%)0.511
Lung Problems16 (13.7%)8 (13.3%)8 (14.0%)0.912
Transient Ischemic Attack3 (2.6%)0 (0%)3 (5.3%)0.072
Stroke with deficit12 (10.3%)6 (10.0%)6 (10.5%)0.925
Social Vulnerability Index Score
High Home Score28 (23.9%)15 (25.0%)13 (22.8%)0.781
High Financial Score10 (8.55%)6 (10.0%)4 (7.0%)0.564
High Transport Score106 (90.6%)52 (86.7%)54 (94.7%)0.135
High Social Score69 (59.0%)39 (65.0%)30 (52.6%)0.174
High Health Score96 (82.1%)50 (83.3%)46 (80.7%)0.711
Modified Fragility Index63 (53.9%)33 (55.0%)30 (52.6%)0.797


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