Abstract
Background: Social determinants of health are emerging as a key group of risk factors for cerebrovascular disease. Carotid artery stenosis (CAS) is an important risk factor for ischemic stroke. We hypothesize that community deprivation, an exposure that captures several social determinants for health, leads to significant disparities in healthcare access in patients with known CAS. Methods: We conducted a cross-sectional study within the All of Us Research Program, a prospective population study that aims to enroll 1 million Americans. We included study participants with CAS, as defined by validated ICD-9/10 codes. We evaluated access to healthcare using 5 metrics included in the Health Care Access and Utilization Survey (Table 1). We evaluated community deprivation using the Deprivation Index, a novel compound metric developed by the American Community Survey. We tested for association between tertiles of the Deprivation Index (labeled low, intermediate and high community deprivation) and health care access using multivariable models adjusting for potential confounders. Results: Of 333,845 participants enrolled in All of Us, we identified 2,465 (0.74%) participants with CAS (mean age 69, 53% female). Of these, 259 (10.5%) could not afford prescription medication, 132 (5.4%) could not afford specialist care, 144 (5.8) skipped medications, 109 (4.4%) could not afford to follow up care and 97 (3.9%) could not afford mental health care. In unadjusted analysis, higher community deprivation was associated with a higher prevalence of all 5 evaluated indicators of poor access to health. In multivariable analysis adjusted for potential confounder variables, difficulty affording prescription medication, specialist care and follow up care remained statistically significant (Table 1). Conclusion: Among persons with CAS enrolled in All of Us, community deprivation was associated with a lower likelihood of accessing and utilizing important healthcare services.
Published Version
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