Applying social vulnerability index to examine social disparities in patients undergoing hysterectomy.

Background: The social vulnerability index (SVI) measures socioeconomic hardship, with high SVI indicating high susceptibility. We applied the SVI to characterize and compare patients who underwent abdominal versus minimally invasive hysterectomy. Objective: To evaluate whether high social vulnerability, as measured by SVI, was associated with a lower likelihood of undergoing minimally invasive hysterectomy compared to abdominal hysterectomy. Study Design: This was a retrospective cohort study conducted across 4 hospitals within a single health system in Colorado. The study included patients who underwent hysterectomy for any indication between 2013 and 2018. Patient addresses were geocoded to estimate overall SVI and its 4 sub-domains: Socioeconomic, Housing/Disability, Race/Minority, and Housing/Transportation. These data were analyzed to evaluate for an association between SVI and surgical approach to hysterectomy. Results: Among 2,619 patients, 86% underwent MIH (87.3% non-Hispanic White [NHW]; 76.6% non-Hispanic Black [NHB]; 82.5% Hispanic). Patients undergoing MIH were more likely to be NHW, ASA class I or II, and less likely to have diabetes, hypertension, or receive care within a tertiary referral center ( Conclusion: Age, race/ethnicity, hospital setting, and ASA class were found to be stronger independent predictors of MIH than SVI. Because race/ethnicity and hospital setting are independently associated with SVI based on prior study, we suspect that including these variables in the analysis weakened the observed independent association between SVI and route of hysterectomy. Further research is required to understand the underlying mechanisms driving surgical disparities, which may include systemic, institutional, or provider-level factors.