High Social Vulnerability Index Research Articles

Does the Political Variable Explain the COVID-19 Event in Brazil?

In effectively confronting the Covid-19 pandemic, it is necessary to complement the contributions of Biomedical Sciences to those offered by the Human Sciences. The theoretical foundations derived from the treatment of the interaction of the infectious agent with the host, primates in formatting the guidelines adopted by the World Health Organization, faced strong opposition from government officials in countries such as Brazil, giving rise to critical pronouncements by researchers in the biomedical sciences in space offered by important scientific journals. Despite being fruitful and strategic in nature, we feel encouraged to consider the objective limits of such investiture, a direct reflection of the lack of dialogue with the Human Sciences, in the field of politics and, mainly, of urbanism. Taking as a starting point the unfolding of the phenomenon in Brazil, specifically in the metropolis of Fortaleza-Ceará, we will show how the "denial" posture is inserted in a broader context, encompassing both a representative political framework of a federative government and including postures of insurgency of the Local Governments (of the federative states) in relation to the Central Government as social and economic aspects that characterize a westernized country to establish impactful filtering genre in the implementation of policies of ordering and control of the singular space. In these terms, the drastic expansion of Covid-19 in Brazil denotes a paradoxical picture to represent: a political context of resistance by Local Governments to minimize the controversial actions and attitudes of the Central Government, specifically the creation of the Forum of Governors in the Northeast to guarantee incorporation WHO international guidelines; a trajectory of unequal and perverse modernization that corroborates the indication of a high number of cases and, mainly, deaths in precarious urbanization areas of cities such as Fortaleza, establishing the periphery as the territory of death, registered in areas with a high social vulnerability index of negatively impact the effective implementation of the social isolation policy.

Using the Social Vulnerability Index to Examine Disparities in Surgical Pediatric Trauma Patients

IntroductionThe Social Vulnerability Index (SVI) is a composite measure geocoded at the census tract level that has the potential to identify target populations at risk for postoperative surgical morbidity. We applied the SVI to examine demographics and disparities in surgical outcomes in pediatric trauma patients. MethodsSurgical pediatric trauma patients (≤18-year-old) at our institution from 2010 to 2020 were included. Patients were geocoded to identify their census tract of residence and estimated SVI and were stratified into high (≥70th percentile) and low (<70th percentile) SVI groups. Demographics, clinical data, and outcomes were compared using Kruskal–Wallis and Fisher's exact tests. ResultsOf 355 patients included, 21.4% had high SVI percentiles while 78.6% had low SVI percentiles. Patients with high SVI were more likely to have government insurance (73.7% versus 37.2%, P < 0.001), be of minority race (49.8% versus 19.1%, P < 0.001), present with penetrating injuries (32.9% versus 19.7%, P = 0.007), and develop surgical site infections (3.9% versus 0.4%, P = 0.03) compared to the low SVI group. ConclusionsThe SVI has the potential to examine health care disparities in pediatric trauma patients and identify discrete at-risk target populations for preventative resources allocation and intervention. Future studies are necessary to determine the utility of this tool in additional pediatric cohorts.

Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations.

We sought to explore the trust and influence community-based organizations have within the communities they serve to inform public health strategies in tailoring vaccine and other health messages. A qualitative study was conducted between March 15 - April 12, 2021 of key informants in community-based organizations serving communities in and around Philadelphia, Pennsylvania. These organizations serve communities with high Social Vulnerability Index scores. We explored four key questions including: (1) What was and continues to be the impact of COVID-19 on communities; (2) How have trust and influence been cultivated in the community; (3) Who are trusted sources of information and health messengers; and (4) What are the community's perceptions about vaccines, vaccinations, and intent to vaccinate in the context of the COVID-19 pandemic. Fifteen key informants from nine community-based organizations who serve vulnerable populations (e.g., mental health, homeless, substance use, medically complex, food insecurity) were interviewed. Five key findings include: (1) The pandemic has exacerbated disparities in existing social determinants of health for individuals and families and have created new concerns for these communities; (2) components of how to build the trust and influence (e.g., demonstrate empathy, create a safe space, deliver on results)resonated with key informants; (3) regardless of the source, presenting health information in a respectful and understandable manner is key to effective delivery; (4) trust and influence can be transferred by association to a secondary messenger connected to or introduced by the primary trusted source; and (5) increased awareness about vaccines and vaccinations offers opportunities to think differently, changing previously held beliefs or attitudes, as many individuals are now more cognizant of risks associated with vaccine-preventable diseases and the importance of vaccines. Community-based organizations offer unique opportunities to address population-level health disparities as trusted vaccine messengers to deliver public health messages.

A Census Tract-Level Examination of Diagnosed HIV Infection and Social Vulnerability Themes Among Black/African American, Hispanic/Latino, and White Adults, 2019-USA.

Assessing HIV diagnosis and the social vulnerability index (SVI) by themes (socioeconomic status, household composition and disability, minority status and English proficiency, and housing type and transportation) might help to identify specific social factors contributing to disparities across census tracts with high rates of diagnosed HIV infection in the USA. We examined HIV rate ratios in 2019 using data from CDC's National HIV Surveillance System (NHSS) for Black/African American, Hispanic/Latino, and White persons aged ≥ 18 years. NHSS data were linked to CDC/ATSDR SVI data to compare census tracts with the lowest SVI (Q1) and highest SVI (Q4) scores. Rates and rate ratios were calculated for 4 SVI themes by sex assigned at birth for age group, transmission category, and region of residence. In the socioeconomic theme analysis, we observed wide within-group disparity among White females with diagnosed HIV infection. In the household composition and disability theme, we observed high HIV diagnosis rates among Hispanic/Latino and White males who lived in the least socially vulnerable census tracts. In the minority status and English proficiency theme, we observed a high percentage of Hispanic/Latino adults with diagnosed HIV infection in the most socially vulnerable census tracts. In the housing type and transportation theme, we observed a high percentage of HIV diagnoses attributed to injection drug use in the most socially vulnerable census tracts. The development and prioritization of interventions that address specific social factors contributing to disparities in HIV across census tracts with high diagnosis rates are critical to reducing new HIV infections in the USA.

Social Vulnerability of Brazilian Metropolitan Schools and Teachers' Absence from Work Due to Vocal and Psychological Symptoms: A Multilevel Analysis.

Teachers' voices and psychological symptoms are the main reasons for absence from work. The objectives of this study were: (i) to spatially represent, through a webGIS, the standardized rates of teachers' absences due to voice (outcome 1) and psychological symptoms (outcome 2) in each Brazilian Federative Unit (FU = 26 states plus Federal District) and (ii) to analyze the relationship between each national outcome rate and the Social Vulnerability Index (SVI) of the municipality where urban schools are located, adjusted for sex, age, and working conditions. This cross-sectional study comprised 4979 randomly sampled teachers working in basic education urban schools, of which 83.3% are women. The national absence rates were 17.25% for voice symptoms and 14.93% for psychological symptoms. The rates, SVI, and school locations in the 27 FUs are dynamically visualized in webGIS. The multilevel multivariate logistic regression model showed a positive association between voice outcome and high/very high SVI (OR = 1.05 [1.03; 1.07]), whereas psychological symptoms were negatively associated with high/very high SVI (OR = 0.86 [0.85 0.88]) and positively associated with intermediate SVI (OR = 1.15 [1.13; 1.16]), in contrast with low/very low SVI. Being a woman (voice: OR = 1.36 [1.35; 1.38]; psychological: 1.22 [1.21; 1.24]) and working in schools with various precarious conditions (17 variables) increased the odds of being absent due to voice and psychological symptoms. The results confirm the need for investments to improve working conditions in schools.

Impact of Social Vulnerability on Long-Term Growth Outcomes in Sutureless Versus Sutured Repair of Gastroschisis.

The purpose of this study is to describe the long-term growth and nutrition outcomes of sutureless versus sutured gastroschisis repair. We hypothesized that weight z-score at 1 year would be affected by social determinants of health measured by the U.S. Centers for Disease Control Social Vulnerability Index (SVI). We conducted a single-center retrospective review of patients who underwent gastroschisis repair (n = 97) from 2007 to 2018. Growth z-scores collected through 5 years of age and long-term clinical outcomes were compared based on the closure method and the type of gastroschisis (simple vs. complicated). Multiple regression analysis was performed to identify the impact of SVI themes and other covariates on weight for age z-score at 1 year. In total, 46 patients underwent sutureless repair and 51 underwent sutured repair with median follow-up duration of 2.5 and 1.9 years, respectively. Weight and length z-scores decreased after birth but normalized within the first year of life. Growth and long-term clinical outcomes were similar regardless of the closure method, while patients with complicated gastroschisis had higher rates of hospitalizations, small bowel obstructions, and additional abdominal surgeries. Using multiple regression, both low discharge weight and high SVI in the "minority status and language" theme were associated with lower weight for age z-scores at 1 year (p = 0.003 and p = 0.03). Sutureless and sutured gastroschisis repairs result in similar growth and long-term outcomes. Patients living in areas with greater social vulnerability may be at increased risk of poor weight gain. Patients should be followed at least through their first year to ensure appropriate growth.

Spatiotemporal Analysis of Thermal Inequity: A Case Study of Hong Kong

In recent years, thermal inequity research has received mounting interest amongst researchers worldwide. The present study aims to conduct a spatiotemporal analysis of thermal inequity in Hong Kong in 2006 and 2016. In this process, the identification of land surface temperature (LST) hotspots and their association with normalised differential vegetation index (NDVI), normalised differential built-up index (NDBI) and social vulnerability index (SoVI) clusters were examined using local Moran’s I spatial autocorrelation. Results show that an increase in the number of LST hotspots from 2006 to 2016 represented the worsening thermal inequity situation in Hong Kong. The low NDVI and high NDBI clusters were respectively discovered in the LST hotspots located in Kowloon and Kwai Tsing. Furthermore, the areas with high LST and high SoVI, represented as the heat vulnerable zones, expanded in the New Territory from 2006 to 2016 but downscaled in Kowloon. Some District Constituency Assembly Areas (DCCAs) in Nam Cheong were found with attributes of high LST, high NDBI, low NDVI and high SoVI in 2006 and 2016. This study concludes that thermal inequity varies spatiotemporally. Recommendations indicate that the socially vulnerable groups in Nam Cheong should be given the highest priority to implement urban heat mitigation and adaptation strategies. The findings will help policymakers to develop and implement proper policies to alleviate thermal inequity in Hong Kong.

INVESTIGATING THE USE OF THE SOCIAL VULNERABILITY INDEX TO PREDICT HEALTHCARE UTILIZATION AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Social factors such as race, education, and financial hardships have been shown to affect health outcomes of patients with inflammatory bowel disease (IBD). Although early identification of socially vulnerable patients is critical for targeted interventions, it is still limited by screening tools that are incomprehensive and time-consuming. We investigate the utility of the social vulnerability index (SVI), a census tract-specific measure estimated by the Centers for Disease Control and Prevention, for predicting patients' healthcare utilization, based on 15 different social determinant variables including employment, housing, and transportation. METHODS We reviewed the electronic health records and surveys of patients with IBD at a private community practice enrolled in IBD Qorus Learning Health System, a national quality improvement consortium, from 2016-2021. Each patient's home address was mapped to an SVI value, ranging from 0 to 1 and increasing as the patient's vulnerability increased. An SVI was considered low if it was less than the median SVI and high if it was greater than or equal to the median SVI. Cox proportional hazards regression was performed to determine the relationship between SVI and healthcare utilization (IBD-related ED visit/hospitalization, urgent message*, and CT scan use), controlling for potential confounders such as IBD subtype, baseline clinical disease activity, physician global assessment, steroid use, and six-months-prior IBD-related ED visit/hospitalization and CT scan use. The “survival time” was defined as the time from when the patient first joined the program to IBD-related healthcare utilization events, loss of follow-up in the electronic health records, or the end of the study period, whichever occurred earliest. RESULTS Among 280 eligible patients, the median SVI was 0.288 (IQR 0.121-0.433) (Figure 1). Among the low SVI group, 16.4% experienced an IBD-related ED visit/hospitalization, 20.0% sent an urgent message, and 10.0% received a CT scan. Among the high SVI group, 23.6% experienced an IBD-related ED visit/hospitalization, 26.4% sent an urgent message, and 12.9% received a CT scan. High and low SVI groups (reference) were not significantly different in their healthcare utilization: ED visit/hospitalization (HR 1.66 [95% CI 0.96-2.89]), sending an urgent message (HR 1.62 [95% CI 0.94-2.70]), and CT scan use (HR 2.31 [95% CI 0.98-5.47]), after adjusting for confounders (Table 1). CONCLUSION IBD-related healthcare utilization was not associated with social vulnerability at the census tract level in this cohort. The lack of statistical significance was likely due to the cohort’s low sample size and lack of demographic variability (92% white and 96.8% non-Hispanic). Additional research with a larger and more diverse sample may help clarify the association between SVI and outcomes.

Disparities in SARS-CoV-2 Infection by Race, Ethnicity, Language, and Social Vulnerability: Evidence from a Citywide Seroprevalence Study in Massachusetts, USA

ObjectivesUncovering and addressing disparities in infectious disease outbreaks require a rapid, methodical understanding of local epidemiology. We conducted a seroprevalence study of SARS-CoV-2 infection in Holyoke, Massachusetts, a majority Hispanic city with high levels of socio-economic disadvantage to estimate seroprevalence and identify disparities in SARS-CoV-2 infection.MethodsWe invited 2000 randomly sampled households between 11/5/2020 and 12/31/2020 to complete questionnaires and provide dried blood spots for SARS-CoV-2 antibody testing. We calculated seroprevalence based on the presence of IgG antibodies using a weighted Bayesian procedure that incorporated uncertainty in antibody test sensitivity and specificity and accounted for household clustering.ResultsTwo hundred eighty households including 472 individuals were enrolled. Three hundred twenty-eight individuals underwent antibody testing. Citywide seroprevalence of SARS-CoV-2 IgG was 13.1% (95% CI 6.9–22.3) compared to 9.8% of the population infected based on publicly reported cases. Seroprevalence was 16.1% (95% CI 6.2–31.8) among Hispanic individuals compared to 9.4% (95% CI 4.6–16.4) among non-Hispanic white individuals. Seroprevalence was higher among Spanish-speaking households (21.9%; 95% CI 8.3–43.9) compared to English-speaking households (10.2%; 95% CI 5.2–18.0) and among individuals in high social vulnerability index (SVI) areas based on the CDC SVI (14.4%; 95% CI 7.1–25.5) compared to low SVI areas (8.2%; 95% CI 3.1–16.9).ConclusionsThe SARS-CoV-2 IgG seroprevalence in a city with high levels of social vulnerability was 13.1% during the pre-vaccination period of the COVID-19 pandemic. Hispanic individuals and individuals in communities characterized by high SVI were at the highest risk of infection. Public health interventions should be designed to ensure that individuals in high social vulnerability communities have access to the tools to combat COVID-19.

Telemedicine use by medicare beneficiaries undergoing hepatopancreatic surgery during COVID-19

Background: The COVID-19 pandemic has played a substantial role in exacerbating pre-existing disparities in access to surgical care. In particular, vulnerable communities have not been able to avail the benefits of telemedicine facilities under the Medicare coverage waiver. We sought to explore the trends and predictive factors associated with telemedicine use. Methods: Patients who underwent hepatopancreatic (HP) surgery between 2013-2020 were identified from the Medicare Standard Analytic Files (SAF). The utilization of telemedicine was quantified after the implementation of the Medicare telemedicine coverage waiver, and data on the county-level social vulnerability index (SVI) were procured from the Centers for Disease Control/Agency for Toxic Substances and Disease Registry. Interrupted time series analysis and multivariable logistic regression were used to assess the association of SVI with telemedicine use. Results: After the waiver, a total of 3,031 patients underwent hepatic (n=1,199, 39.6%), pancreatic (n=1,378, 45.5%) or both surgeries (n=454, 15.0%). The median age was 70 (IQR 66-74), with a majority being female (n=1,599, 52.8%), White (n=2,641, 87.1%), and having a high comorbidity burden [Charlson Comorbidity Index (CCI) >2; n=1,544, 51.3%]. Most patients resided in counties characterized by intermediate social vulnerability [SVI, low: 10.62% (n=322); moderate: 63.84% (n=1,935); high: 25.54% (n=774)]. After the implementation of the waiver, 45.8% (n=1,388) of patients participated in at least one outpatient telemedicine visit. Telemedicine use in the post-waiver period peaked in May 2020 and varied relative to SVI (Low SVI: n=150, 46.58% vs. moderate SVI: n=937, 48.42% vs high SVI: n=301, 38.89%, p2 (referent ≤2; OR 1.49, 95% CI 1.28-1.71) were more likely to use telemedicine (all p< 0.001). Conclusion: These results indicate that patients who lived in highly vulnerable counties and the elderly were less like to have access to telemedicine facilities, while Black patients and those with a high comorbidity burden were more likely to utilize telemedicine. With an ever-increasing dependence on healthcare technology, policies that ensure equitable access to digital resources are required.

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.