Defining urban vascular deserts to improve access to care for disadvantaged populations

Document Type

Article

Publication Date

3-31-2026

Publication Title

JVS- Vascular Insights

Abstract

Objective: Patients in vascular deserts (VDs), previously defined as rural areas lacking vascular providers, face significant barriers to care. This definition fails to consider patients in urban areas facing similar barriers. We compared social determinants of health of participants from urban areas who attended vascular screening events targeting underserved communities to define characteristics of urban VDs (uVDs). Methods: Participants at Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks (CHAMPIONS) events were mapped using ArcGIS. The California Healthy Places Index (HPI), a summation of conditions representing social determinants of health, was used to compare data for participants from VD and non-VD regions. Results: Of 628 CHAMPIONS participants, 387 (62%) were in rural VDs (rVDs) and 214 (38%) were in nondesert urban regions (uVDs). When comparing HPI data, despite closer proximity to vascular care, participants in the CHAMPIONS programs in urban areas were quite disadvantaged, although participants in rVD were more disadvantaged overall (55% vs 28%; P < .001). Minority populations were more prevalent in uVD regions (P < .001). Much of the population lived 200% below the poverty level, more so in rVDs regions (49% vs 70%; P < .001), and contributed more than one-half of their income to housing. Populations in rVD regions were less educated (29% vs 56%; P < .001) with more unemployment (70 vs 44%; P < .001), and more likely to have primary Medi-Cal (68%). One-third of patients in both regions had no primary care provider (29% vs 31% in rVDs). Compared with population-level data, we observed through program participants pockets of patients within uVD areas with decreased education (43% vs 56%; P < .001) and increased poverty (49% vs 68%; P < .001). Conclusions: These findings support prior observations linking limited education and health insurance access to outreach challenges in VDs. Despite improved population-level HPI data in nondesert urban areas, residents of uVDs remain relatively impoverished, undereducated, and in need of improved access to vascular care.

Volume

4

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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