Social Determinants of Health and Atherosclerotic Disease in Vascular Surgery

Social determinants of health (SDoH) are the social, political, socioeconomic, and environmental factors driving the health of patients, which are grouped into five key “determinants”: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.1 In recent years, there has been much research dedicated to elucidating the impact of these factors on minority groups. The impact of socioeconomic status (SES), such as level of education attained and insurance status, on health outcomes has been well-characterized in literature. One study elucidated a correlation between socioeconomic status and all-cause mortality using an Area Deprivation Index (ADI) created by aggregating 17 United States Census factors previously demonstrated to be impactful social determinants of health, such as percentage of families living under the poverty line and residential crowding.2,3 Furthermore, low socioeconomic status has been correlated with higher rates of mortality in patients with cancer and in patients with chronic kidney disease.4–6 The presence of health insurance may help mitigate the negative impact of social determinants of health however disparities in outcome may still persist.7 However, much of the work has focused on socioeconomic status with fewer publications using a more comprehensive view of the multifactorial role of these SDoH factors in creating the environment for disparities to arise and persist.

Aim: Specific Aim 1: Analyze the rate of vascular interventions for patients with atherosclerotic disease in the state of Rhode Island.

We will collect information from patients with atherosclerotic disease who have undergone vascular procedures.

Specific Aim 2: Identify modifiable factors in patients with atherosclerotic disease, particularly as they relate to SDoH, which are associated with worse outcomes post-vascular intervention.

Social determinants of health factors will be elucidated through intentional collection and analysis of patient demographic data, clinical data and application of an area deprivation index percentile scores.

Specific Aim 3: Build a statewide database of patients with atherosclerotic disease who have undergone a vascular intervention.

The goal is to use this database to create an accurate and useful outcomes prediction statistical model that can guide clinical decision-making by identifying high-risk patient groups. By collecting and analyzing data clinical, demographic, and SDoH data we hope to create tangible tools that will improve health outcomes of Rhode Islanders, especially given the prevalence of atherosclerotic disease and vascular interventions.