High Social Vulnerability Index Research Articles

Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities.

Transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe aortic stenosis (AS). It remains unclear whether disparities exist in rural or socially vulnerable populations undergoing TAVR. This study assessed whether outcomes differ based on geographic location or vulnerability of patients undergoing TAVR. Patients undergoing TAVR at a single institution from August 2012 to June 2023 were studied (n = 1565). Zip codes determined Social Vulnerability Index (SVI) and measured distance to our facility. Outcomes defined by the Valve Academic Research Consortium 3 (VARC-3) included stroke, transient ischemic attack (TIA)/delirium, pacemaker implantation, new atrial fibrillation/atrial flutter, and myocardial infarction (MI). Average time between preoperative coronary angiogram (CATH)/computed tomography angiography (CTA) and TAVR was calculated. Kaplan-Meier curves estimated survival probability. The average time between CATH and TAVR in patients living furthest away was ∼9 days more than patients living closest to the implant site. The average number of days between CATH and TAVR for low and high SVI were 71 and 78 days, respectively. The average number of days between CTA and TAVR for low and high SVI were 40 and 39 days, respectively. Further distances traveled were associated with longer wait times between preoperative workup and TAVR. Patients with longer waits between CATH and TAVR had no differences in medium-term survival probability but had decreased long-term survival probability compared to patients with rapid pre-procedural evaluation. Although geographic and socioeconomic vulnerability can disadvantage patients, our study demonstrates that patients undergoing TAVR can have timely care and similar outcomes.

Spatial Patterns of Emergency Dental Care Utilization: Assessing the Influence of Social Vulnerability and Dental Provider Availability.

Our aim was to examine the association between emergency dental care use and dental providers' availability and ZIP code social vulnerability index. This cross-sectional observational study mapped variations in emergency dental care and analyzed their association with social vulnerability using generalized spatial two-stage least-squares to address spatial correlation. To perform spatial autoregressive modeling to examine how dental provider capacity and social vulnerability influence emergency care use across neighboring counties, accounting for ZIP Code Tabulation Area (ZCTA) spillover effects, we used secondary data from the Maryland Health Services Cost Review Commission, InfoUSA, and the US Census American Community Survey. We focused on emergency dental care usage in ZIP Code Tabulation Areas, using emergency department visits and inpatient stays per 1000 residents for dental conditions, as the dependent variable. Highly vulnerable ZCTAs saw 5.9× more non-traumatic dental condition (NTDC) ED visits, 5.3× more chronic dental ED visits, 3.3× more NTDC inpatient stays, and 1.3× more chronic dental inpatient stays than less vulnerable areas. For all four measures of emergency dental care use, increased dental provider availability was associated with reductions in use of emergency dental care (ED), while higher social vulnerability was associated with increased use. For example, an increase of one dental provider per 1000 residents was associated with a reduction of 28.2 non-traumatic dental ED visits, while a high social vulnerability index was associated with an increase of 88.6 non-traumatic dental ED visits. There was an association among dental provider availability, social vulnerability, and the use of emergency dental care.

The Association between the Social Vulnerability Index and Adverse Neonatal Outcomes.

Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission. Retrospective cohort study (2014-2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared. From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96-1.34; high SVI aOR: 1.12, 95% CI: 0.95-1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001-1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (p < 0.001). Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes. · Mean SVI scores are higher in those with a neonate admitted to the NICU.. · There was no observed association between moderate and high SVI scores and NICU admission.. · Moderate SVI is associated with an increased odds of overall neonatal morbidity.. · Greater exposure to low income may be associated with NICU admission..

Spatial and Racial/Ethnic Variation in the Prevalence of Cesarean Delivery in a South Carolina Medical Center.

While racial/ethnic disparities in cesarean delivery have been noted in the literature, less is known about the intersection between individual-level race/ethnicity and community-level social vulnerability as factors in cesarean delivery. The goal was to use medical record data from a large medical center combined with census tract-level data to examine patterns of social vulnerability, racial population distribution, and prevalence of cesarean delivery. Data were obtained from electronic medical records of patients from a large medical center in South Carolina from 2019 to 2020. The outcome variable was cesarean delivery (yes/no), and covariates included the year of delivery; age of patient; race/ethnicity; spoken language; BMI categories; clinical indications of anemia, hypertension, preeclampsia, and diabetes; and census tract Social Vulnerability Index (SVI). Generalized linear mixed models for multilevel binary logistic regression were used to test the main hypothesis that the census tract level Social Vulnerability Index is positively associated with cesarean delivery. Among a total of 5011 patients, we found that non-Hispanic Black mothers were more likely to have cesarean deliveries compared with non-Hispanic White mothers. After controlling for census tract-level SVI, the individual-level race/ethnicity association was no longer significant. Significant spatial autocorrelation across census tracts was evident for cesarean delivery prevalence, non-Hispanic Black population, and SVI. A high prevalence of cesarean delivery tended to cluster with high SVI and a high non-Hispanic Black population. We found that non-Hispanic Black mothers were more likely to have cesarean deliveries, which was explained by census tract differences in the SVI.

8765 Assessment of the Social Vulnerability Index of a 10-Year Retrospective Cohort of Youth with Prediabetes

Abstract Disclosure: D. Somerville: None. R.H. Kolagani, MHS: None. C.E. McCrory: None. S. Budakoti: None. V.M. Chinchilli, PhD: None. J. Joseph: None. D.E. Hale: None. N. Raja-Khan: None. L.P. Huerta Saenz: None. Background: The incidence of prediabetes (preD) is rising among youth in the US. While there are known metabolic risk factors linked to preD development, we were interested in exploring the role of social determinants of health (SDoH) in the development of pediatric preD. The social vulnerability index (SVI) is a tool developed by the CDC to stratify SDoH risk for communities based on 14 factors such socioeconomic status (SES), household composition, race and transportation access. By understanding the role of SVI in the development of preD in youth, we may be able to plan interventions to prevent progression to Type 2 Diabetes (T2D). Objective: Our study goal was to determine the relationship between SVI and preD in youth receiving care at our institution, a large pediatric referral center in Central Pennsylvania. Methods: We conducted a 10-year retrospective chart review of electronic medical records (EMRs) to identify children/youth aged 6-17 years old diagnosed with preD at our pediatric health system between 01/2010 and 01/2020. We used the American Diabetes Association definitions of preD (one or more sub-type): 1) Impaired fasting glucose (IFG), 2) Impaired glucose tolerance (IGT), and 3) Elevated hemoglobin A1c (HA1C). ICD10 codes were used for initial chart identification (R73.01, R73.02, R73.03 and R73.09). The second phase of identification of youth with preD included the review of biological measures of glycemia of the initial identified charts to support the reported ICD10 diagnosis (either isolated subtypes or combinations). Social, demographic characteristics, and residence setting (urban vs. rural) were also investigated. SVI was assessed on a 0-1 scale, with high SVI (0.5-1) indicating greater social vulnerability and low SVI (0-0.49) indicating lower social vulnerability. Rurality was determined per the Health Resources and Services Administration Tool (HRSA). SAS frequencies were calculated. Fisher’s exact tests were applied to compare the frequencies of the aforementioned groups with respect to IFG, IGT, and HA1C. Results: We identified 2700 charts of youth with preD per ICD10 codes search, but only 552 had confirmed preD diagnosis supported by biological data registered in EMRs. The most common preD isolated subtype was HA1C (87.3%), while 12% and 4% had isolated IFG and IGT, respectively. Most youth had high SVI (66.9%) and only 5.8% were rural (p &amp;gt; 0.05). Neither SVI or rurality were associated with isolated preD subtypes, but 8.2% of low-SVI youth had composite [IFG +HA1C] subtypes compared to 3.5% of high-SVI youth (p=0.02). Conclusions: SVI was not significantly associated with any isolated preD subtype. However, youth with the combined preD subtypes [IFG + HA1C] had lower SVI. As T2D is more prevalent in youth from low SES, addressing SDoH at earlier stages of T2D (preD phase) is needed in the effort to prevent the progression of the disease. Presentation: 6/1/2024

Examination of Water Use and Social Vulnerability: A Comparison of Four Communities in Alachua County, Florida

It is projected that about 30% of the world’s major cities will face severe water stress and urban drought from 2050 if climate change continues and has the anticipated effects (Florke et al, 2018; www.wrcwebsite.azurewebsites.net). Socio-economic drought, meaning water shortage in urban life, can have significant effects on a city’s inhabitants, including health and quality of life. Social and economic factors play an important role in planning and decision making of a society (Zhang et al, 2020). The analysis investigated the relationship between socio-economic factors and the use of potable water, its associated impact on aquifer recharge, and potentially identifying major factors influencing water demand and resource sustainability. The Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) and other measures were used for evaluating socio-economic factors. However, since SVI showed weak relationship with water use in the county and the neighborhoods, other socio-economic measures were assessed. Past research had found a correlation between water use and population, GDP, per capita income, electricity usage and irrigated land areas (Alacoma et al., 2007, www.usf.uni-kassel.de/watclim). Therefore, socio economic measures such as population density, household size, per capita income, and poverty rate and irrigation (with and without) potable water were analyzed to evaluate the relationship between water use patterns and these factors across the county and in the communities. The western communities had newer development and less parcels compared to the eastern with much older construction, which impacted their water use. Oakmont with separate reclaimed irrigation meter had lesser usage on potable water. Tioga on the other hand irrigated with potable water. Yearly SVI on a census tract level for the specific years of the study and other socio-economic measures such as population, per capita income, poverty, and household size were used in the analysis. The analysis was performed on four communities in Alachua County, Florida; two at the west and two at the east of the county. Socio-economic measures and physical features were evaluated for communities in the four locations to evaluate whether there is a relationship between water use patterns, spatial characteristics of development such as percent impervious and runoff, and measures of SVI. Spatial and basic statistics was used for this analysis. The western part of the county has had more intensive development in recent years compared to the eastern part of the county. The eastern communities have a high SVI and low potable water use per capita compared to the western communities. The number of households and population were the primary drivers of potable water use per census block. Percent impervious surface and runoff volume did not show any significant. relationship with a community’s SVI. At the parcel level, statistically significant differences were found between communities. For example, potable water use per parcel was lower in communities with high SVI. Keywords: water sustainability, urban water management, social vulnerability index, socio-economic factors, potable water use, aquifer recharge, reclaimed water use, runoff, imperviousness

Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach

BackgroundRural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents. MethodsThis retrospective study included adult patients captured in the Surveillance, Epidemiology, and End Results–Medicare data between January 2008 and December 2015 with an incident stage I to IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was a nonelective cancer-directed surgery among rural vs urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering. ResultsThe sample included 10,136 patients who underwent a surgical intervention; 2941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural than urban patients (351 [27%] and 2590 [29%]; P = .05). There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents (odds ratio, 0.88; 95% CI, 0.76–1.03; P = .11; adjusted odds ratio [aOR], 0.86; 95% CI, 0.72–1.02; P = .080). In addition, high social vulnerability index (SVI) counties or Black race was significantly associated with increase odds of nonelective surgery (aOR, 1.33; 95% CI, 1.07–1.65; P = .009; aOR, 1.49; 95% CI, 1.26–1.77; P < .0001, respectively). ConclusionThis study found no difference in the odds of receiving nonelective surgery for gastrointestinal foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore whether disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.

Impact of Social Vulnerability, Race, and Urbanicity on Early Nutritional Outcomes in Patients With Cleft Palate.

Patients with cleft palate experience early feeding difficulties, resulting in increased hospital utilization due to poor nutritional status. Sociodemographic factors may impact access and outcomes for cleft patients. This study investigates the association of social vulnerability, race, and urbanicity on birth encounter metrics and failure to thrive (FTT) rates for patients with cleft palate. Retrospective data from 2013 to 2023 was queried from Cosmos, a national deidentified database from Epic electronic health record. Birth metrics, the prevalence of FTT, and MyChart activation rates were compared across sociodemographic cohorts based on (1) social vulnerability index (SVI) quartiles, (2) patient race, and (3) USDA Rural-Urban Commuting Area (RUCA) codes using χ2 or Fisher exact tests. There were 92,437 patients diagnosed with cleft palate. Birth weight was lower in socially vulnerable and Black patients (SVI 75%: 101.50±1.57oz; SVI 25%: 106.40±1.85oz; Black: 95.3±2.63oz; White: 104.90±1.02oz; Other: 104.80±2.09oz), and length of stay was longer (SVI 75%: 21±2.39d; SVI 25%: 15±2.18d; Black: 22±4d). FTT related admissions increased with SVI quartile (Q25: 0.19%; Q25-50; 0.29%, Q50-75: 0.34%; Q75: 0.47%; P<0.001). An opposite trend was observed for MyChart activation rates (P<0.001). High SVI and Black patients are susceptible to unfavorable nutritional outcomes. Access disparities, such as direct-to-provider communication systems (ie, MyChart), may contribute. Awareness of social identities, geography, and community may assist in providing individualized care in early life.

Social Vulnerability Index Is Associated With Major Morbidity After Lung Resection

BackgroundLittle is known about the prognostic impact of the Social Vulnerability Index (SVI) in patients with early-stage non-small cell lung cancer (NSCLC) who are undergoing video-assisted thoracoscopic lung resection. MethodsPatients who underwent lung resection for stage IA-IIB NSCLC at a single institution between 2010 and 2021 were included in the study. The Society of Thoracic Surgeons definition of major morbidity, consisting of 14 postoperative events, was used. The SVI was determined by geocoding the permanent addresses of Illinois residents and using the Centers for Disease Control and Prevention calculator for a census-tract level SVI. Univariate and multivariate logistic regression analyses were used to examine the association between the SVI and major morbidity. Cut-point analysis was performed to determine the SVI cutoff that most strongly correlated with major morbidity. ResultsA total of 551 patients met inclusion criteria, and 65% (356 of 551) of these patients underwent lobectomy. The SVI cutoff was determined to be 0.831 (P = .010). In the high-SVI cohort , 58% (26 of 45) were Black, compared with 9% (45 of 506) in the low-SVI cohort (P < .001). For high-SVI patients, the major morbidity rate was 27% vs 9% for low-SVI patients (P = .0174), and the 1-year mortality rate was 8.9% vs. 3.0% for those with a low SVI (P = .061). On univariate analysis, high SVI status was associated with 30-day major morbidity (odds ratio, 2.84; CI, 1.28-6.29; P = .010). On multivariate analysis, after controlling for age, race, sex, tumor histologic type, procedure type, preoperative comorbidities, smoking history, and forced expiratory volume in 1 second, this association persisted (odds ratio, 3.16; CI, 1.11-8.99; P = .031). ConclusionsA high SVI is associated with major morbidity after video-assisted thoracoscopic lung resection for NSCLC.

Upper gastrointestinal cancers: Trends and determinants of location of death

BackgroundPatients diagnosed with upper gastrointestinal cancers often require extensive end-of-life care. We sought to investigate social determinants of health associated with disparities in the location of death among patients who died of upper gastrointestinal cancers. MethodsPatients who died between 2003 and 2020 from esophageal cancer, gastric cancer, hepatobiliary cancer, and pancreatic cancer were identified using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Social determinants of health were assessed using the Social Vulnerability Index. Patients were categorized on the basis of location of death: inpatient hospital, home, nursing home, hospice, and outpatient medical facility/emergency department. Multivariable regression and mediation analyses defined the association of patient race as well as social determinants of health with location of death. ResultsAmong 815,780 decedents (esophageal cancer: 15.3%; gastric cancer: 3.6%; hepatobiliary cancer: 36.6%; pancreatic cancer: 54.5%), most were male (60.8%), aged 55–74 years (52.3%), and White (89.1%). Most decedents died at home (55.7%), followed by inpatient hospital (24.8%), hospice (9.0%), nursing home (8.1%), and outpatient medical facility/emergency department (2.5%). During the study period, location of death shifted notably from inpatient hospital (36.8% to 21.3%) to home (45.8% to 56.3%). Residents of high Social Vulnerability Index areas were more likely to die at inpatient hospital compared with home (31.8% vs 24.3%) (P < .001). Black race (reference: White; odds ratio; 0.41, 95% confidence interval, 0.40–0.42) and social vulnerability (reference: low Social Vulnerability Index; odds ratio, 0.64, 95% confidence interval, 0.63–0.65) remained independently associated with lower odds of dying at home compared with an inpatient hospital. Notably, 65% of the overall race-based association with death at inpatient hospital was driven indirectly through social determinants of health. ConclusionSocial determinants are important drivers of end-of-life care and impact the potential ability of patients with cancer to die at home.

Abstract P365: Prevalence of Hypertension in Minnesota Adults in 2023 Using Data from a Statewide Electronic Health Record Consortium

Background: Data on prevalence of hypertension in the United States come primarily from in-person data collected by the National Health and Nutrition Examination Survey and self-reports in the Behavioral Risk Factor Surveillance Survey. Electronic phenotypic algorithms for hypertension that include diagnosis codes, blood pressure values, and antihypertensive treatment have been proposed and tested. Objective: To describe prevalence of hypertension in Minnesota adults using data from a statewide electronic health record (EHR) consortium, the Minnesota EHR Consortium (MNEHRC). Methods: Data from 11 health systems participating in the MNEHRC were standardized to a common data model allowing for distributed querying of EHR data. Data were de-duplicated using a one-way hash algorithm. Preliminary prevalence of hypertension in 2023 was estimated in Minnesota residents with ≥ 1 encounter in the past 3 years who had ≥1 diagnosis of hypertension in the past 5 years. Medicaid insurance status was determined via linkage with state enrollment files. Residential addresses of patients were geocoded to census tracts and social vulnerability index (SVI) of census tracts was determined. Results: Among 4,369,470 Minnesotan age 18 and older in 2023, 23.6% had hypertension based on ≥1 diagnosis code. Prevalence increased with age, was higher in men (26% vs. 22% in women), and adjusted for age and sex was highest in Black (30%) and Native American (27%) compared with White (23%) and Hispanic (21%) Minnesotans. Within each race/ethnic group, those insured by Medicaid had a higher adjusted hypertension prevalence than those with other insurance types. The prevalence of hypertension in census tracts with moderate to high SVI ranged from 3% to 43%, but on average was similar to the statewide prevalence of 24% (see image 1). Prevalence of hypertension in race/ethnicity, sex, and age subgroups in higher SVI census tracts was similar to the statewide prevalence in those subgroups. Conclusions: The prevalence of hypertension in Minnesota was described in detail by demographic characteristics, geography and social vulnerability. Future work will expand the electronic hypertension phenotype and examine quality of care.

Impact of social vulnerability index on patients with alcohol-related liver disease

IntroductionAlcohol related liver disease (ALD) affects diverse communities with individual and social characteristics that can impact outcomes. The social vulnerability index (SVI) assigns a score between 0 and 1, where higher scores represent an increased risk of social vulnerability. We sought to assess the impact of SVI on outcomes of patients hospitalized with ALD with access to social support services. Methods and materialsHospitalizations for ALD at our institution between March and August 2019 were reviewed. All patients were assigned an SVI score based on their residential census tract. Per our standard practice, patients were screened by care coordinators to identify needs for rehabilitation counseling, and care coordination after discharge. Demographics, hepatic decompensation, critical care needs, readmission, and mortality were compared. ResultsAmong 73 patients admitted for alcoholic hepatitis, 32 had a low SVI and 42 had a high SVI. African American patients were more likely to have a higher SVI (35% vs 0%, p=<0.001). No significant difference in outcomes based on SVI was noted.There were 393 patients admitted for alcoholic cirrhosis including 166 with a low SVI and 227 with a high SVI. Patients that were African American (23.6% vs 5.5%, p=<0.001) or disabled (41.4% vs 29.5%, p = 0.008) had a higher SVI. No significant difference in outcomes based on SVI was noted. ConclusionMost patients admitted for ALD had a high SVI; however, SVI did not impact hospitalization outcomes.

Workplace Exposures Vary Across Neighborhoods in the US: Implications on Social Vulnerability and Racial/Ethnic Health Disparities.

Ignoring workplace exposures that occur beyond the local residential context in place-based risk indices like the CDC's Social Vulnerability Index (SVI) likely misclassifies community exposure by under-counting risks and obscuring true drivers of racial/ethnic health disparities. To investigate this hypothesis, we developed several place-based indicators of occupational exposure and examined their relationships with race/ethnicity, SVI, and health inequities. We used publicly available job exposure matrices and employment estimates from the United States (US) Census to create and map six indicators of occupational hazards for every census tract in the US. We characterized census tracts with high workplace-low SVI scores. We used natural cubic splines to examine tract level associations between the percentage of racial/ethnic minorities (individuals who are not non-Hispanic White) and the occupational indicators. Lastly, we stratified each census tract into high/low occupational noise, chemical pollutant, and disease/infection exposure to examine racial/ethnic health disparities to diabetes, asthma, and high blood pressure, respectively, as a consequence of occupational exposure inequities. Our results show that racial/ethnic minority communities, particularly those that are also low-income, experience a disproportionate burden of workplace exposures that may be contributing to racial/ethnic health disparities. When composite risk measures, such as SVI, are calculated using only information from the local residential neighborhood, they may systematically under-count occupational risks experienced by the most vulnerable communities. There is a need to consider the role of occupational justice on nationwide, racial/ethnic health disparities.

Association of US county-level social vulnerability index with breast, colorectal, and lung cancer screening, incidence, and mortality rates across US counties.

Despite being the second leading cause of death in the United States, cancer disproportionately affects underserved communities due to multiple social factors like economic instability and limited healthcare access, leading to worse survival outcomes. This cross-sectional database study involves real-world data to explore the relationship between the Social Vulnerability Index (SVI), a measure of community resilience to disasters, and disparities in screening, incidence, and mortality rates of breast, colorectal, and lung cancer. The SVI encompasses four themes: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation. Using county-level data, this study compared cancer metrics in U.S. counties and the impact of high and low SVI. Two-sided statistical analysis was performed to compare SVI tertiles and cancer screening, incidence, and mortality rates. The outcomes were analyzed with logistic regression to determine the odds ratio of SVI counties having cancer metrics at or above the median. Our study encompassed 3,132 United States counties. From publicly available SVI data, we demonstrated that high SVI scores correlate with low breast and colorectal cancer screening rates, along with high incidence and mortality rates for all three types of cancers. County level SVI has impact on incidence rates of cancers; breast cancer rates were lowest in high SVI counties, while colorectal and lung cancer rates were highest in the same counties. Age-adjusted mortality rates for all three cancers increased across SVI tertiles. After risk adjustment, a 10-point SVI increase correlated with lower screening and higher mortality rates. In conclusion, our study establishes a significant correlation between SVI and cancer metrics, highlighting the potential to identify marginalized communities with health disparities for targeted healthcare initiatives. It underscores the need for further longitudinal studies on bridging the gap in overall cancer care in the United States.

Social Vulnerability and National Diabetes Prevention Program Recognition Status

IntroductionThe CDC National Diabetes Prevention Program (National DPP) aims to reduce the incidence of diabetes in the U.S. Organizations delivering the National DPP receive pending, preliminary, full, or full-plus recognition status based on specific program criteria and outcomes. Achieving full/full-plus recognition is critical for organizations to sustain the program and receive reimbursements to cover costs, but organizations in disadvantaged areas may face barriers to obtaining this level of recognition. This study examined the association between county-level social vulnerability and full/full-plus recognition status within the National DPP. MethodsUsing the 2022 National DPP registry and the 2018 CDC Social Vulnerability Index (SVI), a three-level categorical dependent variable was created (n=843): counties without organizations having full/full-plus recognition, counties with at least one organization not having full/full-plus recognition, and counties with all organizations having full/full-plus recognition. A multinomial logit model was analyzed in 2023 to examine the association between SVI and in-person full/full-plus recognition organizations at the county level, adjusting for confounders. ResultsCompared to counties with low social vulnerability, counties with higher social vulnerability had significantly higher odds of having no organizations with full/full-plus recognition. For example, counties with high SVI had 2.63 (95% CI: 1.55-4.47) times higher odds of having no organizations with full/full-plus recognition compared to having all organizations with full/full-plus CDC recognition. ConclusionsThe findings suggest disparities in the National DPP recognition status among organizations in vulnerable communities. Developing strategies to ensure organizations in high social vulnerability areas achieve at least full recognition status is critical for program sustainability and reducing diabetes-related health disparities.

Vulnerable populations and the emergency ventral hernia: A retrospective cohort study

IntroductionVentral hernias can be repaired electively; however, many circumstances require emergency repair. The association between sociodemographic status and rate of emergency repair are unclear and the Social Vulnerability Index may be a useful tool to better understanding this association. The purpose of this study was to investigate the association between Social Vulnerability Index and emergency ventral hernia repair. MethodsThis was a retrospective cohort study using the National Surgical Quality Improvement Program (2012–2018) data for patients at a level 1 trauma center. We included patients who had an open ventral hernia repair. Social Vulnerability Index was based on residential address at the time of surgery. We conducted univariate and bivariate statistics, including χ2 and Mann-Whitney U tests to compare high and low social vulnerability. ResultsOur sample had 1,017 patients. Patients who underwent emergency operations were older (P = .025) and had higher Social Vulnerability Index (P = .029). Patients in the high Social Vulnerability Index group were 1.5 times more likely to receive emergency surgery (P = .047). Emergency repair was also associated with increased frequency of nonhome discharge (9% vs 2%, P = .001) and higher mean work relative value unit (15.4 vs 11.9, P < .001). ConclusionPatients requiring emergency ventral hernia repair have significantly higher Social Vulnerability Index than those undergoing elective repair. This vulnerable population also has increased cost associated with the repair and higher rates of nonhome discharge. This work provides a foundation for efforts to reach patients in high Social Vulnerability Index environments at an earlier stage to achieve earlier elective repair.

Social disparities in delivery choice among patients with history of cesarean

ObjectiveGiven the call to reduce rates of non-medically indicated cesarean deliveries (CDs) by encouraging trials of labor after cesarean (TOLAC), this study looks at social characteristics of patients choosing a TOLAC versus a scheduled repeat cesarean delivery (SRCD) to determine disparities regarding delivery method choice. MethodsThis was a retrospective cohort study of patients with a history of one CD between April 29, 2015–April 29, 2020. Patients were divided based on type of delivery chosen at admission. Chi-squared tests examined proportional differences between groups and logistic regression models examined odd ratios of choosing TOLAC versus SRCD according to socially dependent categories including race/ethnicity, health insurance, pre-pregnancy body mass index, and Social Vulnerability Index (SVI). Results1,983 patients were included. Multivariable logistic regression models revealed that patients with a high SVI (reference: low/medium SVI) (AOR 2.0, CI: 1.5, 2.5), self-identified as Black/ African American (AOR: 2.4, CI: 1.6, 3.6) or Hispanic/Latina (AOR: 2.0, CI: 1.4, 2.8) (reference: White), had public insurance (reference: private insurance) (AOR: 3.7, CI: 2.8, 5.0), and who had an obese BMI (reference: non-obese BMI) were more likely to opt for a TOLAC rather than SRCD. ConclusionThese findings demonstrate differences in delivery method preferences. Specifically, more disadvantaged patients are more likely to choose TOLAC, suggesting that social and economic factors may play a role in delivery preferences. These findings have implications for improving individualized counselling and engaging in shared decision-making around mode of delivery.

Impact of social vulnerability index on severity of obstructive sleep apnea: Insights from drug-induced sleep endoscopy

ObjectivesTo examine the association between neighborhood-level social vulnerability on the severity of obstructive sleep apnea (OSA) in patients undergoing drug-induced sleep endoscopy (DISE). Study designSingle center retrospective cohort study. MethodsWe conducted a retrospective chart review of patients >18 years of age that underwent DISE from July 2016 to July 2022. Patient addresses were geocoded with geographic information systems, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores in the four sub-themes: Socioeconomic (theme 1), Household Composition/Disability (theme 2), Minority Status/Language (theme 3), and Housing/Transportation (theme 4). ResultsThe study included 165 patients (61.2 years ± 11.6; 31.0 BMI ± 6.1, 102 male, 63 female). Mild OSA was present in13 patients; 55 patients had moderate OSA; and 97 patients had severe OSA. A higher SVI value in minority status and language, and a higher BMI both predicted an increased Apnea Hypopnea Index (AHI) (p = 0.042, and <0.001, respectively) in the multivariate model; whereas, race, age, gender, or the other three SVI sub-theme values were not predictive. ConclusionAdults residing in areas of greater social vulnerability – specifically a larger minority presence or English as a second language – and patients who are obese are more likely to have more severe OSA. There was no correlation, however, between obesity and residence in an area of high SVI. These results suggest that both neighborhood conditions and obesity are associated with OSA severity. This elevated risk has potential implications for diagnostic testing, clinic follow-ups, screening, and treatment plans for adults residing in disenfranchised neighborhoods. Level of evidenceIV.

Association of social vulnerability and rehospitalization in pediatric motor vehicle trauma patients

IntroductionWe investigated social vulnerability index (SVI) as a tool to identify children at risk for readmission following motor vehicle collisions (MVC). Materials and MethodsAn exploratory retrospective cohort study was conducted of pediatric trauma activations (age 0–15) for MVCs 1/1/2012 to 6/30/2022 at a level 1 trauma center. Eligibility included residence within our center's catchment area. Excluded were mortalities during the index admission. Patient address was geocoded and linked with state-level census tract SVI. Per the CDC, SVI ≥90th percentile defined high vulnerability. We evaluated SVI theme: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), housing and transportation (HT). Outcomes included emergency department (ED) visits and re-hospitalization within 90 days of discharge. Kaplan-Meier plots, relative risk (aRR), and 95 % confidence intervals (95 %CI) adjusted for injury severity score (ISS) were estimated using log-binomial regression. ResultsOf 429 eligible subjects, 122 (28 %) resided in high SVI communities. High SVI patients had slightly higher mean ISS (8.6 vs 7.5). There was a similar risk of ED re-presentation across SVI groups (aRR=1.18; 95 %CI 0.61–2.29). However, although estimates were unstable, there was a possibility of increased risk of re-hospitalization among the high SVI group (aRR=2.34; 95 %CI 0.68–8.04). By theme, HT had the strongest association (aRR=1.71) for ED representation, whereas SES and HCD had the strongest associations for rehospitalization (aRR=2.03, 2.66, respectively). ConclusionWe observed possible associations between high SVI and higher rates of re-hospitalization. Future research with a larger sample may clarify associations. Level of EvidenceLevel IV; Prognosis Study.

Waitlist Time, Age, and Social Vulnerability: Impact on the Survival Benefit of Deceased Donor Kidney Transplantation Versus Long-term Dialysis Among Patients With End-stage Renal Disease.

We sought to define the survival benefit of kidney transplantation versus long-term dialysis relative to waitlist time on dialysis, social vulnerability, and age among end-stage renal transplant candidates. End-stage renal disease patients who were candidates for their first deceased donor kidney transplantation between 2008 and 2020 were identified using the US Renal Data System. Survival probabilities for patient survival were compared using the restricted mean survival times (RMSTs) across different age and social vulnerability index (SVI) ranges. Among 149 923 patients, 68 795 (45.9%) patients underwent a kidney transplant and 81 128 (54.1%) remained on dialysis. After propensity-score matching (n = 58 035 in each cohort), the 5-y RMST difference between kidney transplant and dialysis demonstrated an increasing trend in mean life-years gained within 5 y of follow-up relative to advancing age (<30 y: 0.40 y, 95% confidence interval, 0.36-0.44 y versus >70 y: 0.75 y, 95% confidence interval, 0.70-0.80 y). Conversely, disparities in 5-y RMSTs remained consistent relative to social vulnerability (median 5-y RMST difference: 0.62 y comparing low versus high SVI). When considering waitlist duration, stratified analyses demonstrated increasing trends across different age groups with the largest RMST differences observed among older patients aged ≥70 y. Notably, longer waitlist durations (>3 y) yielded more pronounced RMST differences compared with shorter durations (<1 y). These data underscore the survival benefit associated with kidney transplantation over long-term dialysis across various age and SVI ranges. Transplantation demonstrated a greater advantage among older patients who had a longer waitlist duration.