Social Vulnerability Index and Surgical Management of Abnormal Uterine Bleeding in Reproductive-Age Women

Abnormal uterine bleeding (AUB) is common and affects 10% to 50% of reproductive-age women. A large number of nonmedical factors in the social and physical environment have a strong effect on health outcomes in patients with AUB and other disorders/diseases. Patients with lower household income or public health insurance and those belonging to minoritized racial and ethnic groups are less likely to have minimally invasive gynecologic surgery. The Social Vulnerability Index (SVI) was developed by the Centers for Disease Control and Prevention (CDC) and measures a community's vulnerability in each census tract, with higher scores indicating increased social vulnerability. The CDC SVI ranks each census tract on 15 social factors and groups them into 4 related themes: (1) socioeconomic status, (2) household composition, (3) race/ethnicity/language, and (4) housing/transportation. Each census tract receives a separate ranking for each of the 4 themes, as well as an overall ranking. The vulnerability score ranges from 0 (least vulnerable) to 1 (most vulnerable). The SVI is also divided into quartiles, with Q4 being the highest social vulnerability category. The aims of this retrospective study were to determine whether surgical management of AUB in reproductive-age women is associated with SVI and to evaluate whether the surgical procedure (hysterectomy or myomectomy) and approach (laparotomy or laparoscopy) differed based on SVI. Data were evaluated from 7 hospitals and 4 ambulatory surgery centers within a health system between January 1, 2019, and October 31, 2021. The address of residence was used to identify each patient's census tract. Patient census tracts were then linked to SVI scores released by the CDC and the Agency for Toxic Substances and Disease Registry. Separate multiple logistic regression analyses were performed to evaluate the association between surgical approach (laparoscopy or laparotomy) and SVI quartiles for each of the 2 surgical procedures (hysterectomy and myomectomy). Adjusted models controlled for age, race and ethnicity, marital status, insurance, language, body mass index, a history of cesarean delivery or myomectomy, and type of facility. A total of 1628 eligible patients were included. Patients resided in 922 different census tracts (298 zip codes). In the hysterectomy group, the odds of laparotomy was not associated with SVI quartile before (univariate) and after adjustment (multivariate). In the myomectomy group, the odds of laparotomy in univariate analysis was 1.86 times (95% confidence interval, 1.27-2.72) higher in SVI Q3 than Q1 and 1.74 times (95% confidence interval, 1.15-2.62) higher in SVI Q4 than SVI Q1; however, the adjusted odds ratios were smaller and not statistically significant. The authors conclude that patients with AUB in minoritized racial and ethnic groups are more likely to have a laparotomy than a minimally invasive procedure. Treatment of AUB is not only influenced by individual clinical and sociodemographic characteristics but also by the neighborhood environments in which patients reside.