High Social Vulnerability Index Research Articles

Associations of Neighborhood Opportunity and Social Vulnerability With Trajectories of Childhood Body Mass Index and Obesity Among US Children

Physical and social neighborhood attributes may have implications for children's growth and development patterns. The extent to which these attributes are associated with body mass index (BMI) trajectories and obesity risk from childhood to adolescence remains understudied. To examine associations of neighborhood-level measures of opportunity and social vulnerability with trajectories of BMI and obesity risk from birth to adolescence. This cohort study used data from 54 cohorts (20 677 children) participating in the Environmental Influences on Child Health Outcomes (ECHO) program from January 1, 1995, to January 1, 2022. Participant inclusion required at least 1 geocoded residential address and anthropometric measure (taken at the same time or after the address date) from birth through adolescence. Data were analyzed from February 1 to June 30, 2022. Census tract-level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) linked to geocoded residential addresses at birth and in infancy (age range, 0.5-1.5 years), early childhood (age range, 2.0-4.8 years), and mid-childhood (age range, 5.0-9.8 years). BMI (calculated as weight in kilograms divided by length [if aged <2 years] or height in meters squared) and obesity (age- and sex-specific BMI ≥95th percentile). Based on nationwide distributions of the COI and SVI, Census tract rankings were grouped into 5 categories: very low (<20th percentile), low (20th percentile to <40th percentile), moderate (40th percentile to <60th percentile), high (60th percentile to <80th percentile), or very high (≥80th percentile) opportunity (COI) or vulnerability (SVI). Among 20 677 children, 10 747 (52.0%) were male; 12 463 of 20 105 (62.0%) were White, and 16 036 of 20 333 (78.9%) were non-Hispanic. (Some data for race and ethnicity were missing.) Overall, 29.9% of children in the ECHO program resided in areas with the most advantageous characteristics. For example, at birth, 26.7% of children lived in areas with very high COI, and 25.3% lived in areas with very low SVI; in mid-childhood, 30.6% lived in areas with very high COI and 28.4% lived in areas with very low SVI. Linear mixed-effects models revealed that at every life stage, children who resided in areas with higher COI (vs very low COI) had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographic and prenatal characteristics. For example, among children with obesity at age 10 years, the risk ratio was 0.21 (95% CI, 0.12-0.34) for very high COI at birth, 0.31 (95% CI, 0.20-0.51) for high COI at birth, 0.46 (95% CI, 0.28-0.74) for moderate COI at birth, and 0.53 (95% CI, 0.32-0.86) for low COI at birth. Similar patterns of findings were observed for children who resided in areas with lower SVI (vs very high SVI). For example, among children with obesity at age 10 years, the risk ratio was 0.17 (95% CI, 0.10-0.30) for very low SVI at birth, 0.20 (95% CI, 0.11-0.35) for low SVI at birth, 0.42 (95% CI, 0.24-0.75) for moderate SVI at birth, and 0.43 (95% CI, 0.24-0.76) for high SVI at birth. For both indices, effect estimates for mean BMI difference and obesity risk were larger at an older age of outcome measurement. In addition, exposure to COI or SVI at birth was associated with the most substantial difference in subsequent mean BMI and risk of obesity compared with exposure at later life stages. In this cohort study, residing in higher-opportunity and lower-vulnerability neighborhoods in early life, especially at birth, was associated with a lower mean BMI trajectory and a lower risk of obesity from childhood to adolescence. Future research should clarify whether initiatives or policies that alter specific components of neighborhood environment would be beneficial in preventing excess weight in children.

30: SOCIAL VULNERABILITY INDEX AND CHILD OPPORTUNITY INDEX HIGH IN ASTHMA BUT NOT LINKED TO PICU STAY

Introduction: Racial and socioeconomic disparities in pediatric asthma prevalence, severity, and use of primary and emergency care have been well studied. However, understanding of the impact of these disparities on risk of hospitalization in the pediatric intensive care unit (PICU) is limited. We used composite measures of socioeconomic risk factors through the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), and the Child Opportunity Index (COI) 2.0 to compare patients admitted for status asthmaticus to the PICU or pediatric ward at Children’s Hospital Los Angeles (CHLA). We hypothesized patients with a high SVI and low COI are at higher risk for PICU level care. Methods: Following IRB approval, patients were identified using ICD-10 codes for asthma. The outcome of interest was need for PICU versus ward care. Patients were included as requiring PICU level of care if admitted to the PICU during their stay. Patient registered street address was geocoded and linked to US Census-American Community Survey 2019 Data (5-Year) at the census tract level. Bivariate analysis with the patient’s SVI, COI, hospital length of stay (LOS), and PICU admission were conducted. Statistical analysis used SAS, STATA, and ArcGIS Pro. Results: From [October 2015 – May 2022], there were 4,766 admissions matched to addresses from 3,617 distinct patients of which 626 (13.1%) required PICU admission. Overall median SVI for all patients was 0.86 with no difference between groups for SVI: median (1,3 IQR) PICU 0.86 (0.67, 0.93) Ward 0.86 (0.69, 0.93) p=0.56; or for COI: PICU 27 (9, 50) Ward 24 (10, 50) p=0.82. Hospital LOS was significantly longer for those requiring PICU admission: PICU 3 (3, 5) Ward 2 (2, 3) (days) p< 0.001. Conclusions: We found that children admitted to CHLA for asthma had an elevated SVI overall reflecting a patient population among the lowest socioeconomic status in the United States. The median 0.86 SVI score indicates a population that is more socially vulnerable than all but 14% of the US population. Similarly, the COI score demonstrated a population at risk. Yet, there was no difference between groups for the SVI or COI scores indicating we care for children at increased socioeconomic risk, but this did not increase PICU use for asthma admissions.

Using the social vulnerability index to assess COVID-19 vaccine uptake in Louisiana

Using data from the Louisiana Department of Public Health, we explored the spatial relationships between the Social Vulnerability Index (SVI) and COVID-19-related vaccination and mortality rates. Publicly available COVID-19 vaccination and mortality data accrued from December 2020 to October 2021 was downloaded from the Louisiana Department of Health website and merged with the SVI data; geospatial analysis was then performed to identify the spatial association between the SVI and vaccine uptake and mortality rate. Bivariate Moran’s I analysis revealed significant clustering of high SVI ranking with low COVID-19 vaccination rates (1.00, p < 0.001) and high smoothed mortality rates (0.61, p < 0.001). Regression revealed that for each 10% increase in SVI ranking, COVID-19 vaccination rates decreased by 3.02-fold (95% CI = 3.73–2.30), and mortality rates increased by a factor of 1.19 (95% CI = 0.99–1.43). SVI values are spatially linked and significantly associated with Louisiana’s COVID-19-related vaccination and mortality rates. We also found that vaccination uptake was higher in whites than in blacks. These findings can help identify regions with low vaccination rates and high mortality, enabling the necessary steps to increase vaccination rates in disadvantaged neighborhoods.

Social vulnerability during the COVID-19 pandemic in Peru.

The COVID-19 pandemic has demanded governments and diverse organizations to work on strategies to prepare and help communities. Increasing recognition of the importance of identifying vulnerable populations has raised a demand for better tools. One of these tools is the Social Vulnerability Index (SVI). The SVI was created in 2011 to identify and plan assistance for socially vulnerable populations during hazardous events, by providing disaster management personnel information to target specific areas. We aimed to evaluate and determine the social vulnerability in different provinces and districts of Peru in the context of the COVID-19 pandemic using an adapted version of the SVI index. Ecological, observational, and cross-sectional study was conducted. We adapted the SVI and collected indicators related to COVID-19. We organized and analyzed the population data of the 196 provinces of Peru, using data from government institutions. We found a distribution of high and very high SVI in the mountainous areas of Peru. High and very high social vulnerability indexes, due to the presence of some or all the variables were predominantly distributed in the provinces located in the southern and highlands of the country. The association between mortality rate and social SVI-COVID19 was inverse, the higher the vulnerability, the lower the mortality. Our results identify that the provinces with high and very high vulnerability indexes are mostly located in rural areas nearby the Andes Mountains, not having a direct correlation with COVID-19 mortality.

The Impact of Social Vulnerability Index on Survival Following ASCT for Multiple Myeloma

Background: The prognosis of patients with multiple myeloma (MM) has significantly improved with the advancement of highly effective therapies. High dose chemotherapy with an autologous hematopoietic stem cell transplant (ASCT) continues to be the standard of care for eligible patients with MM. While several factors affect survival following ASCT, the impact of social determinants of health, especially the local level social vulnerability, on survival in this patient population is not well documented. This study will use the CDC Social Vulnerability Index (SVI) to capture local levels of social vulnerability. Composed of 15 social factors, SVI is a constantly evolving measure of a community's ability to respond to hazardous events and helps public health officials identify populations in most need of support. SVI has traditionally been used for natural disaster outreach, but recently has been studied in cancer patients. These social factors are grouped into four related themes (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), which comprise a community's overall vulnerability ranking. The areas with higher levels of SVI are at a higher risk during public health emergencies. Aim: This study evaluated the impact of SVI and other social determinants of health on progression free survival (PFS) following an ASCT. Methods: A retrospective analysis of patients who underwent an ASCT in a single center from 2012 to 2020 was conducted. Patients were followed from time of diagnosis to 5 years post-transplant, if applicable. Socioeconomic data was obtained using the transplant center's database, the 2003 rural-urban continuum codes provided by US Department of Agriculture, and the CDC SVI, which uses census statistical data to identify the most vulnerable populations. Variables examined included age, gender, race, primary insurance payor, geographic location (urban/rural), and SVI, with a higher SVI implying a greater level of vulnerability among the county. Logistic regression analysis was performed to determine the odds ratios (OR) for the primary endpoint of PFS and for the secondary endpoint of overall survival (OS), while controlling for characteristics. Logistic regression using both full set of control variables and stepwise selection method were used to identify key predictors of PFS and OS. Results: 225 consecutive patients with MM who received ASCT participated, with the majority having been transplanted in the last 5 years. 151 (67%) achieved PFS at 5 years post-transplant and 171 (76%) remained alive at 5 years post-transplant. 209 (93%) patients received post-transplant maintenance therapy, and 77 (34%) had high-risk cytogenetics according to mSMART 3.0 criteria. The majority (72%) of the study population were Non-Hispanic White and most patients (60%) had public insurance payors. Race, insurance payor, or living in urban/rural areas did not affect PFS or OS. 53 (24%) patients lived in high SVI areas (SVI above median of SVI distribution). Treating SVI as a continuous value from 0 to 1, as the CDC scores SVI, we found that higher SVI values were significantly associated with lower odds of PFS post-transplant (OR=0.347, p<0.05). Patients living in higher SVI communities also saw a trend toward lower OS (OR=0.321) post-transplant (p<0.10). Of patients living in high SVI areas, only high-risk cytogenetics were significantly associated with lower odds of PFS (OR=0.0693, p<0.01) and OS (OR=0.294, p<0.05). Conclusion: Data from this single center retrospective study demonstrated that a higher SVI was associated with a lower PFS, while race, insurance payor, and urban/rural location had no significant association with PFS. This suggests that areas with high SVI may need more resources to achieve optimal PFS. Future studies will focus on efforts to address the factors in SVI, so all patients have opportunities for excellent outcomes after ASCT for MM. Factors that may be prudent to concentrate on include transportation, housing, and employment, as these components may be more easily intervened upon in future studies. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 10463: Neighborhood Social Vulnerability and Interstage Weight Gain: Evaluating the Role of a Home Monitoring Program

Introduction: Interstage (IS) growth failure is a risk factor for poor outcomes in infants with hypoplastic left heart syndrome (HLHS). We hypothesize that children with greater social vulnerability are at greater risk for IS growth failure. However, IS home monitoring may mitigate disparities in IS weight gain. We sought to examine the impact of an Infant Single Ventricle Management and Monitoring Program (ISVMP) on the association of neighborhood social vulnerability and IS weight gain. Methods: We performed a retrospective single-center cohort study of infants with HLHS before (2007-2010) and after (2011-2020) the introduction of the ISVMP. IS weight gain was measured in grams per day (gm/day) and growth failure was defined as an average IS weight gain of &lt;20 gm/day. Neighborhood social vulnerability was measured by the Centers for Disease Control Social Vulnerability Index (SVI) with higher SVI values representing greater vulnerability. Linear and logistic regression models were used to examine the association between SVI and IS weight gain and growth failure. Models were adjusted for demographic, operative, and discharge characteristics. To test for effect modification by ISVMP, we introduced an interaction term into the models and calculated pre- and post- stratum-specific effect estimates. Results: In total, 328 infants with HLHS, were evaluated 111 before and 217 after the introduction of the ISVMP. In the total cohort, SVI was significantly associated with IS growth failure (P= 0.001). Enrollment in ISVMP strongly attenuated the association of SVI and IS growth failure (P = 0.04). Prior to ISVMP, infants in the highest and middle SVI tertiles gained 4 gm/day less than infants in the lowest SVI tertile and were more likely to experience IS growth failure (high vs. low: aOR 12.5; 95% CI 2.5-62.2; middle vs. low: aOR 7.8; 95% CI 2.0-31.2). However, after the introduction of the ISVMP, there was no difference in IS weight gain or growth failure by SVI tertile. Middle and high SVI infants enrolled in ISVMP gained 4 gm/day and 2 gm/day more than their pre-ISVMP counterparts, respectively. Conclusion: High social vulnerability is a risk factor for poor IS weight gain in infants with HLHS. However, enrollment in ISVMP significantly reduces growth disparities.

Space-Time Clustering and Socioeconomic Factors Associated with Mortality from Diarrhea in Alagoas, Northeastern Brazil: A 20-Year Population-Based Study.

Acute diarrhea is the second leading cause of death among children in developing countries and is strongly related with the socioeconomic conditions of the population. In Brazil, data show a drop in the diarrhea mortality rate. Nevertheless, the northeastern region still has the most deaths. Considering this, we analyze high-risk areas for diarrhea- and gastroenteritis-related deaths, and their association with social determinants of health (SDH) in the state with one of the worst human development indicators in Brazil (Alagoas) between 2000 and 2019. We applied temporal, spatial, and space–time risk modelling. We used a log-linear regression model to assess temporal trends and the local empirical Bayesian estimator, the global and local Moran indices for spatial analysis. Spearman’s correlation was used to correlate mortality rates with SDH. A total of 3472 diarrhea-related deaths were reported during this period in Alagoas. We observed a decreasing time trend of deaths in the state (9.41/100,000 in 2000 to 2.21 in 2019; APC = −6.7; p-value < 0.001), especially in children under one year of age. However, there was stability among adults and the elderly. We identified two high-risk spatiotemporal clusters of mortality in inland municipalities. Lastly, mortality rates correlated significantly with 90% of SDH. Taken together, these findings indicate that diarrhea diseases remain a serious public health concern in Alagoas, mainly in the poorest and inland municipalities. Thereby, it is urgently necessary to invest in measures to control and prevent cases, and improve the living conditions of the poorest populations and those with the highest social vulnerability index.

Duration of Behavioral Policy Interventions and Incidence of COVID-19 by Social Vulnerability of US Counties, April-December 2020.

State-issued behavioral policy interventions (BPIs) can limit community spread of COVID-19, but their effects on COVID-19 transmission may vary by level of social vulnerability in the community. We examined the association between the duration of BPIs and the incidence of COVID-19 across levels of social vulnerability in US counties. We used COVID-19 case counts from USAFacts and policy data on BPIs (face mask mandates, stay-at-home orders, gathering bans) in place from April through December 2020 and the 2018 Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention. We conducted multilevel linear regression to estimate the associations between duration of each BPI and monthly incidence of COVID-19 (cases per 100 000 population) by SVI quartiles (grouped as low, moderate low, moderate high, and high social vulnerability) for 3141 US counties. Having a BPI in place for longer durations (ie, ≥2 months) was associated with lower incidence of COVID-19 compared with having a BPI in place for <1 month. Compared with having no BPI in place or a BPI in place for <1 month, differences in marginal mean monthly incidence of COVID-19 per 100 000 population for a BPI in place for ≥2 months ranged from -4 cases in counties with low SVI to -401 cases in counties with high SVI for face mask mandates, from -31 cases in counties with low SVI to -208 cases in counties with high SVI for stay-at-home orders, and from -227 cases in counties with low SVI to -628 cases in counties with high SVI for gathering bans. Establishing COVID-19 prevention measures for longer durations may help reduce COVID-19 transmission, especially in communities with high levels of social vulnerability.

S1385 Impact of Social Vulnerability Index on Outcomes in Patients With Alcohol-Related Liver Disease

Introduction: Alcohol related liver disease affects diverse communities with individual and social characteristics that can impact outcomes. The Social Vulnerability Index (SVI) integrates a range of metrics and assigns a score between 0 and 1, where higher scores represent an increased risk of social vulnerability. Vulnerable patients with alcohol related liver disease have been reported to have worse outcomes. We sought to assess the impact of SVI on outcomes of patients hospitalized with alcohol related liver disease with access to social support services. Methods: Hospitalizations for alcohol related liver disease at our institution between March and August 2019 were reviewed. All patients were assigned a low or high SVI score based on their residential census tract. Per our standard practice, patients were screened by multi-disciplinary care coordinators to identify needs for rehabilitation counseling, transplant workup, and care coordination after discharge. Demographics, hepatic decompensation, critical care needs, readmission and mortality were compared. Results: Among 73 patients admitted for alcoholic hepatitis, 32 had a low SVI (mean 0.25) and 42 had a high SVI (mean 0.72). African American patients were more likely to have a higher SVI (35% vs 0%, p=< 0.001). Severity of alcohol hepatitis based on discriminant factor (DF) was similar between high and low SVI patients (mean DF 39.6 vs 42.8, p=0.72). After controlling for race, there was not a significant difference in hepatic decompensation, critical care needs, readmission rate or mortality based on SVI. There were 393 patients admitted for alcoholic cirrhosis including 166 with a low SVI (mean 0.26) and 227 with a high SVI (mean 0.73). 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. MELD-Na scores were similar between the high and low SVI patients (mean MELD-Na 21.7 vs 22.9, p=0.47). After controlling for age, race and employment, there was not a significant difference in hepatic decompensation, critical care needs, readmission rate or mortality based on SVI. Conclusion: Most patients admitted for alcohol related liver disease had a high SVI; however, SVI did not impact outcomes in our cohort of patients. This may be a result of extensive care coordination efforts at our institution aimed at reducing barriers for vulnerable patients. These early interventions likely decrease the effect of SVI on outcomes.

Social vulnerability index (SVI) and poor postoperative outcomes in children undergoing surgery in California

IntroductionArea-based social determinants of health (SDoH) associated with disparities in children's surgical outcomes are not well understood, though some may be risk factors modifiable by public health interventions. MethodsThis retrospective cohort study investigated the effect of high social vulnerability index (SVI), defined as ≥90th percentile, on postoperative outcomes in children classified as ASA 1–2 who underwent surgery at a large institution participating in the National Surgical Quality Improvement Program (2015–2021). Primary outcome was serious postoperative complications, defined as postoperative death, unplanned re-operation, or readmission at 30 days after surgery. ResultsAmong 3278 pediatric surgical procedures, 12.1% had SVI in the ≥90th percentile. Controlling for age, sex, racialization, insurance status, and language preference, serious postoperative complications were associated with high overall SVI (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.02–2.44) and high socioeconomic vulnerability (SVI theme 1, OR 1.75, 95% CI 1.03–2.98). ConclusionNeighborhood-level socioeconomic vulnerability is associated with worse surgical outcomes in apparently healthy children, which could serve as a target for community-based intervention.

The Association between Social Vulnerability and Frailty in Community Dwelling Older People: A Systematic Review.

The aim of this systematic literature review was to determine whether social vulnerability is associated with frailty in older people. Databases were searched for literature from January 2001 to March 2022. Hand searches of reference lists of the selected articles were also used to identify other relevant studies. Studies that met the inclusion criteria were selected. Two independent reviewers assessed the methodological quality using an established tool. Eleven eligible studies from Canada, Europe, USA, Tanzania, Mexico, and China were selected. The level of social vulnerability measured by the Social Vulnerability Index (SVI) from a meta-analysis was 0.300 (95% CI: 0.242, 0.358), with the highest SVI in Tanzania (0.49), while the lowest level of SVI was reported in China (0.15). The highest frailty level of 0.32 was observed in both Tanzania and Europe, with the lowest frailty reported in a USA study from Hawaii (0.15). In all studies, social vulnerability was a significant predictor of mortality for both sexes at subsequent data collection points. The association between SVI and frailty was high in Tanzania (r = 0.81), with other studies reporting stronger correlations for females compared to males, but at small to moderate levels. In one study, an increase of 1SD in SVI was linked to a 20% increase in frailty score at a subsequent evaluation. Additional study is warranted to determine a potential causality between social vulnerability and frailty.

Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals

ObjectiveTo evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals. MethodsProspective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey. ResultsOf 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56). ConclusionsPregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.

Characteristics and Geographic Variation in Sudden Unexpected Infant Deaths in the District of Columbia.

Sleep-related infant death is a major cause of infant mortality in the United States. In the District of Columbia, infant mortality varies widely among regions (2 to 14 per 1000 live births). The study objectives were to analyze the patient characteristics and related variables to sudden unexpected infant deaths at 2 pediatric emergency department (ED) sites and the geographic patterns of infant deaths and their relationship to social vulnerability. This retrospective cohort study examined infants under 1 year of age presenting with cardiac arrest at 2 ED sites from 2010 to 2020. Analysis showed 81 deaths with a median population age of 75 days (SD, 46 days). The most frequent demographics of deceased patients were African American Black (89%) with Medicaid insurance (63%), born at term gestation (66%), and without comorbidity (60%). The cause of death was most frequently undetermined (32%) and asphyxia (31%). Most cases involved bed-sharing (63%), despite more than half of those cases having a known safe sleep surface available. Infant death location showed that most deaths occurred in areas with the highest social vulnerability index, including near a community ED location. Understanding the etiologies of this geographic variability may enhance sleep-related infant death prevention strategies.

Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States

BackgroundRacial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). ObjectivesThe aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. MethodsThe Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC’s Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. ResultsThe AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. ConclusionsComorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.

Impact of maternal social vulnerability and timing of prenatal care on outcome of prenatally detected congenital heart disease.

Early prenatal detection of congenital heart disease (CHD) allows mothers to plan for their pregnancy and delivery; however, the effect of certain sociodemographic and fetal factors on prenatal care has not been investigated thoroughly. This study evaluated the impact of maternal and fetal characteristics on the timing of prenatal diagnosis of CHD and fetal and postnatal outcomes. This retrospective multicenter cohort study included women with a fetal echocardiographic diagnosis of CHD between 2010 and 2019. Women were grouped into quartiles of social vulnerability (quartiles 1-4; low-high) using the 2014 social vulnerability index (SVI) provided by the Centers for Disease Control and Prevention. A fetal disease severity score (range, 1-7) was calculated based on a combination of CHD severity (mild = 1; moderate = 2; severe, two ventricles = 3; severe, single ventricle = 4 points) and prenatally diagnosed genetic abnormality, non-cardiac abnormality and fetal hydrops (1 point each). Late diagnosis was defined as a fetal echocardiographic diagnosis of CHD after 24 weeks' gestation. Univariate and multivariable regression analyses were used to identify factors associated with late diagnosis, termination of pregnancy (TOP), postnatal death, prenatal-postnatal discordance in CHD diagnosis and severity and, for liveborn infants, to identify which prenatal variables were associated with postnatal death or heart transplant. Among 441 pregnancies included, 94 (21%) had a late diagnosis of CHD. Late diagnosis was more common in the most socially vulnerable quartile, 38% of women in this group having diagnosis > 24 weeks, compared with 14-18% in the other three quartile groups. Late diagnosis was also associated with Catholic or other Christian religion vs non-denominational or other religion and with a lower fetal disease severity score. There were 93 (21%) TOP and 26 (6%) in-utero fetal demises. Factors associated with TOP included early diagnosis and greater fetal disease severity. Compared with the other quartiles, the most socially vulnerable quartile had a higher incidence of in-utero fetal demise and a lower incidence of TOP. Among the 322 liveborn infants, 49 (15%) died or underwent heart transplant during the follow-up period (range, 0-16 months). Factors associated with postnatal death or heart transplant included longer delay between obstetric ultrasound examination at which CHD was first suspected and fetal echocardiogram at which CHD was confirmed and greater fetal disease severity. High social vulnerability, Catholic or other Christian religion and low fetal disease severity are associated with late prenatal CHD diagnosis. Delays in CHD diagnosis are associated with fewer TOPs and worse postnatal outcome. Therefore, efforts to expedite fetal echocardiography following abnormal obstetric screening, particularly for at-risk women (e.g. those with high SVI), have the potential to impact pregnancy and postnatal outcome among the prenatally diagnosed CHD population. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

The win ratio: A novel approach to define and analyze postoperative composite outcomes to reflect patient and clinician priorities

BackgroundThe “win ratio” (WR) is a novel statistical technique that hierarchically weighs various postoperative outcomes (eg, mortality weighted more than complications) into a composite metric to define an overall benefit or “win.” We sought to use the WR to assess the impact of social vulnerability on the likelihood of achieving a “win” after hepatopancreatic surgery. MethodsIndividuals who underwent an elective hepatopancreatic procedure between 2013 and 2017 were identified using the Medicare database, which was merged with the Center for Disease Control and Prevention's Social Vulnerability Index. The win ratio was defined based on a hierarchy of postoperative outcomes: 90-day mortality, perioperative complications, 90-day readmissions, and length of stay. Patients matched based on procedure type, race, sex, age, and Charlson Comorbidity Index score were compared and assessed relative to win ratio. ResultsAmong 32,557 Medicare beneficiaries who underwent hepatectomy (n = 11,621, 35.7%) or pancreatectomy (n = 20,936, 64.3%), 16,846 (51.7%) patients were male with median age of 72 years (interquartile range 68–77) and median Charlson Comorbidity Index of 3 (interquartile range 2–8), and a small subset of patients were a racial/ethnic minority (n = 3,759, 11.6%). Adverse events associated with lack of a postoperative optimal outcome included 90-day mortality (n = 2,222, 6.8%), postoperative complication (n = 8,029, 24.7%), readmission (n = 6,349, 19.5%), and length of stay (median: 7 days, interquartile range 5–11). Overall, the patients from low Social Vulnerability Index areas were more likely to “win” with a textbook outcome (win ratio 1.07, 95% confidence interval 1.01–1.12) compared with patients from high social vulnerability counties; in contrast, there was no difference in the win ratio among patients living in average versus high Social Vulnerability Index (win ratio 1.04, 95% confidence interval 0.98–1.10). In assessing surgeon volume, patients who had a liver or pancreas procedure performed by a high-volume surgeon had a higher win ratio versus patients who were treated by a low-volume surgeon (win ratio 1.21, 95% confidence interval 1.16–1.25). In contrast, there was no difference in the win ratio (win ratio 1.01, 95% confidence interval 0.97–1.06) among patients relative to teaching hospital status. ConclusionUsing a novel statistical approach, the win ratio ranked outcomes to create a composite measure to assess a postoperative “win.” The WR demonstrated that social vulnerability was an important driver in explaining disparate postoperative outcomes.

Quantifying inequities in COVID-19 vaccine distribution over time by social vulnerability, race and ethnicity, and location: A population-level analysis in St. Louis and Kansas City, Missouri.

Equity in vaccination coverage is a cornerstone for a successful public health response to COVID-19. To deepen understanding of the extent to which vaccination coverage compares with initial strategies for equitable vaccination, we explore primary vaccine series and booster rollout over time and by race/ethnicity, social vulnerability, and geography. We analyzed data from the Missouri Department of Health and Senior Services on all COVID-19 vaccinations administered across 7 counties in the St. Louis region and 4 counties in the Kansas City region. We compared rates of receiving the primary COVID-19 vaccine series and boosters relative to time, race/ethnicity, zip-code-level Social Vulnerability Index (SVI), vaccine location type, and COVID-19 disease burden. We adapted a well-established tool for measuring inequity-the Lorenz curve-to quantify inequities in COVID-19 vaccination relative to these key metrics. Between 15 December 2020 and 15 February 2022, 1,763,036 individuals completed the primary series and 872,324 received a booster. During early phases of the primary series rollout, Black and Hispanic individuals from high SVI zip codes were vaccinated at less than half the rate of White individuals from low SVI zip codes, but rates increased over time until they were higher than rates in White individuals after June 2021; Asian individuals maintained high levels of vaccination throughout. Increasing vaccination rates in Black and Hispanic communities corresponded with periods when more vaccinations were offered at small community-based sites such as pharmacies rather than larger health systems and mass vaccination sites. Using Lorenz curves, zip codes in the quartile with the lowest rates of primary series completion accounted for 19.3%, 18.1%, 10.8%, and 8.8% of vaccinations while representing 25% of the total population, cases, deaths, or population-level SVI, respectively. When tracking Gini coefficients, these disparities were greatest earlier during rollout, but improvements were slow and modest and vaccine disparities remained across all metrics even after 1 year. Patterns of disparities for boosters were similar but often of much greater magnitude during rollout in fall 2021. Study limitations include inherent limitations in the vaccine registry dataset such as missing and misclassified race/ethnicity and zip code variables and potential changes in zip code population sizes since census enumeration. Inequities in the initial COVID-19 vaccination and booster rollout in 2 large US metropolitan areas were apparent across racial/ethnic communities, across levels of social vulnerability, over time, and across types of vaccination administration sites. Disparities in receipt of the primary vaccine series attenuated over time during a period in which sites of vaccination administration diversified, but were recapitulated during booster rollout. These findings highlight how public health strategies from the outset must directly target these deeply embedded structural and systemic determinants of disparities and track equity metrics over time to avoid perpetuating inequities in healthcare access.

Social vulnerability to agricultural drought: Insights from Northern Cape, South Africa

Understanding the complexities of catastrophe susceptibility, including that caused by agricultural droughts, is crucial to disaster risk reduction. This paper assessed and identified the social vulnerability of smallholder livestock farmers in South Africa's Northern Cape Province to agricultural drought using survey data, the social vulnerability index (SVI), and the Bogardi, Birkman, and Cardona (BBC) conceptual framework. The SVI for Northern Cape Province, with a Likert scale score of 3.5, indicated high vulnerability. Variables such as cultural values and practices, and security were the major contributors to social vulnerability to agricultural drought (very high SVI score of 5). Farmers' age, gender participation (power imbalance between men and women in decision-making), psychological stress, and external assistance all contributed to social vulnerability to agricultural drought with an SVI score of 4. With an SVI score of 3, social reliance and education level also contributed to societal vulnerability to agricultural drought. Preparedness strategies and indigenous knowledge had an SVI score of 2, indicating low vulnerability and positively contributing to agricultural drought resilience. The study recommends that stock theft and farm attacks should be reduced by enhancing or improving livestock and farm security. The government and other stakeholders should educate farmers to enhance their knowledge by understanding the advantages and disadvantages of cultural values and practices. This could be accomplished by enlisting the help of key industry players.

One regional health system, two distinct geographic patterns in locally advanced cervical cancer: Implications for informing public health efforts for intervention (369)

<b>Objectives:</b> Cervical cancer is preventable but remains a significant burden, with 14,480 new cases estimated in the US in 2021. Disparities in cervical cancer incidence and mortality include race/ ethnicity, socioeconomic status, and geographic location. We aimed to utilize geospatial analyses to examine patterns of cervical cancer incidence and identify populations at the highest risk, understand their unique risk factors, and use this information to inform public health efforts for intervention. <b>Methods:</b> A descriptive retrospective chart review and spatial epidemiological pilot was conducted at a regional health system in Northeast Ohio with a catchment area including rural and middlesized metropolitan/urban areas. Patients with locally advanced cervical cancer (FIGO stages IB3 - IV) diagnosed from January 2015 to March 2021 were geocoded based on their address at the time of diagnosis (<i>n</i>=165). These geocoded points were analyzed within a Geographic Information System (GIS) to identify geographic patterns, and in particular, to detect localized clusters and investigate neighborhood-level associations with social vulnerability as defined by the Center for Disease Control and Prevention Social Vulnerability Index (SVI). <b>Results:</b> Patients with locally advanced cervical cancer exhibit both clustered and dispersed patterns across the region. The two most prominent clusters were identified within specific neighborhoods in the cities of Cleveland and Elyria. In both cases, these clusters were geographically associated with areas of high SVI and a range of poor health outcomes. Additionally, there was a dispersed pattern across rural areas of the region, and these areas were associated with low SVI, meaning they were more advantaged. <b>Conclusions:</b> The two different geographic patterns, clustered in urban areas of high SVI and dispersed across rural areas of low SVI, may be indicative of inadequate access to care. That access barrier, however, may be driven by different processes based on geography and patient demographics. Additional parameters beyond SVI may be necessary to capture poverty and social disadvantage in rural areas and will be explored in subsequent studies. Identifying reasons for these two distinct geographic patterns of cervical cancer burden is the next step in this study to enable place-based interventions.

Abstract 3662: Association of US county-level social vulnerability index (SVI) with breast and colon cancer screening rates

Abstract Introduction: Whether social determinants of health (SDOH) affect US breast and colon cancer screening rates remains unclear. That said, in 2011 the CDC began recording a social vulnerability index (SVI) for all US counties. SVI was designed to capture four SDOH: socioeconomic status (SES), household composition and disability, minority status and language, and housing type and transportation. This retrospective study sought to determine the association of county-level SVI with breast and colon cancer screening rates. Methods: We used publicly available data from the CDC 2018 SVI database to collect SVI scores for every US county. SVI scores range from 0.1 to 1. A lower score indicates low vulnerability, while a higher score suggests high vulnerability. SVI scores were merged with publicly available data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS) containing county modeled estimates for breast and colon cancer screening rates. Counties were then divided into &amp;lt; 50th percentile and &amp;gt;= 50th percentile for breast and colon cancer screening. SVI scores and their four SDOH were compared between groups. Statistical significance between groups was assessed at an alpha less than 0.5. Linear regression was used to identify the association between high county-level SVI and the probability of being &amp;gt;= 50th percentile in breast and colon cancer screening. Results: This study involved 3,109 counties. Compared to counties &amp;gt;= 50th percentile in breast cancer screening (n = 1543), those &amp;lt; 50th percentile (n = 1566) were significantly worse off in SES (0.60 ± 0.27 vs. 0.41 ± 0.27), household composition and disability (0.58 ± 0.28 vs. 0.42 ± 0.28), minority status and language (0.51 ± .30 vs. 0.49 ± .28), housing type and transportation (0.53 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.58 ± 0.28 vs. 0.42 ± 0.27) (p &amp;lt; .0001). Likewise, compared to counties &amp;gt;= 50th percentile in colon cancer screening (n = 1548), those &amp;lt; 50th percentile (n = 1561) were also significantly worse off in SES (0.63 ± 0.27 vs. 0.38 ± 0.25), household composition and disability (0.59 ± 0.27 vs. 0.41 ± 0.27), minority status and language (0.54 ± .30 vs. 0.45 ± .27), housing type and transportation (0.54 ± 0.29 vs. 0.46 ± 0.28), and overall SVI (0.61 ± 0.28 vs. 0.39 ± 0.27) (p &amp;lt; .0001). High SVI counties compared with low SVI counties were significantly less likely to be &amp;gt;= 50th percentile in breast cancer and colon cancer screening, OR 0.24 (95% CI 0.20 - 0.29) and 0.14 (95% CI 0.12 - 0.18). Finally, county-level SVI percentile correlated negatively with breast and colon cancer screening rates, Pearson coefficient -0.35 and -0.46. Conclusions: This study highlights the significant impact of US county-level SVI on breast and colon cancer screening rates, signaling the need for more effective intervention strategies and allocation of resources to help improve SDOH for our country's most vulnerable citizens. Citation Format: Akhil Mehta, Eric Lau, Gayathri Nagaraj, Hamid Mirshahidi. Association of US county-level social vulnerability index (SVI) with breast and colon cancer screening rates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3662.