Understanding the impact of social determinants of health on wait time for Mohs surgery

Summary: Mohs surgery is considered the best treatment for high-risk skin cancers including basal cell (BCC) and squamous cell (SCC) carcinomas. Considering the aggressive nature of BCC and SCC, Mohs surgery should be performed as early as possible to achieve optimal results. This correlational research study sought to determine whether there is any correlation between wait time for Mohs surgery and Area Deprivation Index (ADI), a measurement for social determinants of health. The 2021 Medicare Provider Utilization and Payment Data dataset was used to identify and contact Mohs surgeon offices to collect Mohs surgery wait time data. The Neighborhood Atlas was used to collect ADI associated with each Mohs surgeon’s office zip code. The mean Mohs surgery wait time was 4.9 and 4.4 weeks for BCC and SCC, respectively. The Spearman rank correlations between Mohs surgery wait time for BCC and ADI as well as SCC and ADI were 0.09 (p<0.001) and 0.06 (p=0.003), respectively. Geographic analysis was performed with heat maps showing the distribution of Mohs surgeons across the US. There is a statistically significant positive correlation between Mohs surgery wait time and ADI for both BCC and SCC. Additionally, there is a geographic maldistribution of Mohs surgeons with rural areas having less access to Mohs surgery. These discrepancies impact patient outcomes and exacerbate existing health disparities. Moving forward, it is essential to address these discrepancies, so we can work to ensure equitable access to Mohs surgery for those in underserved and under-resourced areas. John Monroe¹, Ella Engels², Joseph Rigdon³, Christine Ahn³, Franki Lambert Smith⁴ 1. SUNY Upstate Medical University Norton College of Medicine, Syracuse, NY, United States. 2. University of Rochester School of Medicine and Dentistry, Rochester, NY, United States. 3. Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC, United States. 4. Dermatology, University of Rochester Medical Center, Rochester, NY, United States. Clinical Research: Epidemiology and Observational Research