Associations Between Neighborhood Social Vulnerability and the Distribution of Rhinologists in the United States

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OBJECTIVE: Assess the geographic distribution of US rhinologists in relation to neighborhood-level social determinants of health (SDoH) as measured by the Social Vulnerability Index (SVI). STUDY DESIGN: Cross-sectional. SETTING: United States. METHODS: The American Rhinologic Society directory was queried for US rhinologists and their practice addresses. The distribution of rhinologists was examined at the state and census tract level. SVI scores for each census tract were grouped into four quartiles across Overall SVI and four subthemes: socioeconomic status (SES), household composition and disability status (HH), racial-ethnic minority status (RE), and housing-transportation status (HT). The distance from each census tract to the nearest rhinologist was calculated and linear regression assessed associations between distance and SVI. RESULTS: A total of 808 rhinologists were included in this study. States with the greatest density of rhinologists included Wyoming, Vermont, and the District of Columbia; states with the lowest density included North Dakota, South Dakota, Alaska, and Maine. On multivariable analysis, higher vulnerability in SES (β = 1.517 [95% CI: 1.491, 1.544], P < .001) and HH (β = 1.487 [1.466, 1.509], P < .001) was associated with significantly increased distance to the nearest rhinologist. In contrast, higher vulnerability in RE (β = 0.347 [0.342, 0.353], P < .001) and HT (β = 0.926 [0.913, 0.940], P < .001) was associated with significantly decreased distance to the nearest rhinologist. CONCLUSION: Neighborhood-level distance to rhinologists in the United States is associated with neighborhood-level SDoH as measured by SVI. Future studies should assess the impact of rhinologist proximity on health outcomes.

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