The association between social vulnerability index and neonatal intensive care unit admission

Abstract

The social vulnerability index (SVI) measures a community’s vulnerability to external stressors on health and is composed of four themes. Higher community-level SVI has been associated with adverse maternal outcomes. We evaluated the association between SVI and neonatal intensive care unit (NICU) admission. Retrospective cohort study of all patients delivering >22 weeks gestational age at our institution (2014-2018). Patients with only a PO box address, multiple gestations, or known fetal anomalies were excluded. Patient addresses were used to assign each individual a community-level composite SVI score and a score for each theme. The primary outcome was NICU admission. We compared mean composite SVI scores (95% CIs) and for each theme; individual components of each theme were also compared between those with and without NICU admissions. From 2014-2018, 13,757 patients were included for analysis. Overall, 2837 (21%) had a neonate with a NICU admission. Patients with the highest SVI scores were more likely to be obese, not non-Hispanic white, and use tobacco (p< 0.001) compared to those with lower SVI scores. Patients whose neonates had NICU admissions had higher overall and individual theme mean SVI scores, with the exception of Theme 3: minority status/language (Table). Those requiring NICU admission had lower per capita income, were less likely to have a high school diploma, more likely to live with people who are disabled or ≥ 65 years of age, or live in mobile homes or households with more people and were less likely to have minority/non-English speakers in the home compared to those without NICU admission (Table, p< 0.001). Patients who deliver a neonate requiring NICU admission have higher mean SVI scores both overall and from a variety of social themes including household composition, housing type, and SES. Targeted prenatal care strategies in these patients and increasing social support may improve perinatal outcomes.