High Social Vulnerability Research Articles

Determinants of belief in conspiracy theories about the war in Ukraine among youth

AbstractConspiracy theories are particularly prevalent in times of crisis and pose a major threat to democracy. Young people are especially susceptible to conspiracy theories, as this period is characterized by high social vulnerability and constant reflection on one's position in society. However, to date little is known about the determinants of young people's belief in conspiracy theories in general and in times of crisis in particular. In this study, we address this research gap by investigating the belief of young people in Germany (N = 2437, aged 16 to 29) in conspiracy theories about the war in Ukraine. Drawing on Douglas and colleagues’ (2017) taxonomy, we find that epistemic (e.g., political self‐efficacy), existential (e.g., political trust), and social (e.g., social exclusion) motives influence belief in conspiracies about the war among young people. However, while the taxonomy suggests equal influence of the three motives, the effects of feelings of social exclusion on war‐related conspiracy beliefs among youth are mainly mediated by a strong influence of political distrust. In this way, our findings contribute to a better understanding of conspiracy beliefs among young people and highlight the importance of increasing young people's political trust to prevent the spread of conspiracy theories.

Vulnerability and Colorectal screening during the pandemic

ObjectiveDisparities in colorectal cancer (CRC) screening prevalence across United States neighborhoods may reflect social inequities that create barriers to accessing and completing preventive health services. Our objective was to identify whether neighborhood social vulnerability was associated with a change in CRC screening prevalence in Boston neighborhoods during the COVID-19 pandemic. MethodsAdults ages 50–74 years due for CRC screening who received primary care at one of 35 primary care practices affiliated with Massachusetts General Hospital or Brigham and Women’s Hospital (Boston, MA), 3/1/2020 to 3/1/2022. The Social Vulnerability Index (SVI) is an aggregate measure of neighborhood social factors often used by public health authorities to examine neighborhood susceptibility to many health outcomes. ResultsIn 2020, 74.9 % of eligible individuals were up to date with CRC screening and this fell to 67.4 % in 2022 (p < 0.001). In 2020, 36.2 % of eligible patients lived in a neighborhood above the 80th percentile of SVI, consistent with high social vulnerability, while the same value was 35.1 % in 2022. There was no association between the change in screening prevalence and SVI: a decrease of 5.5 % screened in neighborhoods with SVI ≤ 80 compared to a decrease of 3.6 % in neighborhoods with SVI > 80 (p = 0.79). ConclusionsThe COVID-19 pandemic equalized the prevalence of CRC screening across Boston-area neighborhoods despite pre-existing geographic disparities in screening prevalence and SVI. Strategies to ensure equitable participation in CRC screening to promote health equity should be considered to promote equitable pandemic recovery.

Pediatric obesity during COVID-19: the role of neighborhood social vulnerability and collective efficacy.

Childhood obesity increased in the first year of COVID-19 with significant disparities across race, ethnicity, and socioeconomic status. Social distancing led to fewer physical activity opportunities but increased screen time and high-calorie food consumption, all co-determined by neighborhood environments. This study aimed to test the moderation effects of neighborhood socioeconomic and built environments on obesity change during COVID-19. Using electronic health records from a large pediatric primary care network in 2018-2022, we cross-sectionally examined 163,042 well visits of 2-17-year-olds living in Philadelphia County in order to examine (1) the pandemic's effect on obesity prevalence and (2) moderation by census-tract-level neighborhood socioeconomic disadvantage, crime, food and physical activity-related environments using interrupted-time-series analysis, Poisson regression, and logistic regression. Weekly obesity prevalence increased by 4.9 percent points (pp) during the pandemic (January 2021-August 2022) compared to pre-pandemic (March 2018-March 2020) levels. This increase was pronounced across all age groups, racially/ethnically minoritized groups, and insurance types (ranging from 2.0 to 6.4 pp) except the Non-Hispanic-white group. The increase in obesity among children racially/ethnically minoritized groups was significantly larger in the neighborhoods with high social vulnerability (3.3 pp difference between high and low groups), and low collective efficacy (2.0 pp difference between high and low groups) after adjusting for age, sex, and insurance type. Racially/ethnically minoritized children experienced larger obesity increases during the pandemic, especially those in socioeconomically disadvantaged neighborhoods. However, the buffering effect of community collective efficacy on the disparities underscores the importance of environments in pediatric health.

Abstract B079: Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment in Arizona

Abstract Background: Hispanics and American Indians (AI) have a higher kidney cancer incidence and mortality in Arizona. This study assessed 1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability, measured using the social vulnerability Index (SVI), experience a longer time (in days) to surgical treatment for kidney cancer after clinical diagnosis, and 2) whether time to surgery, race and ethnicity, and neighborhood social vulnerability are associated with adverse pathology (upstaging to pT3), progression free survival (PFS), and overall survival (OS) in Arizona. Methods: Arizona Cancer Registry (2009-2018) data for kidney and renal pelvis cases were obtained. Logistic regression models were used to assess if SVI (&amp;lt;25, 25-49, 50-74, and ≥75 percentile) and race and ethnicity were associated with a longer time to surgical (&amp;gt;median time to surgery) and upstaging. Cox-regression hazard models were used to assess if time to surgery and SVI were associated with PFS and OS. Separate analyses were performed for each clinical stage (cT1a, cT1b, cT2, and cT3). Results: A total of 4,592 kidney and renal pelvis cases (16.6% Hispanics and 4.8% AI) were included. Hispanic and AI patients with T1 tumors had a longer time to surgery than NHW patients (median time of 56, 55, and 45 days respectively). In unadjusted models, Hispanic ethnicity was associated with a longer time to surgery for cT1a (OR 1.48, 95% CI:1.05-2.08) and cT1b (OR 1.87, 95% CI:1.14-3.07). Hispanic and AI patients were also more likely to live in neighborhoods with high SVI than NHW patients. Living in neighborhoods with high (≥75) versus low (&amp;lt;25) overall SVI increased odds of a longer time to surgical for cT1a (OR 1.54, 95% CI:1.02-2.31) and cT2 (OR 2.32, 95% CI:1.13-4.73) in adjusted models. In these adjusted models, Hispanic ethnicity was no longer significantly associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3 (OR 1.95, 95% CI: 0.99-3.84) and risk of mortality. A longer time to surgery was associated with PFS with HR 1.52 (95% CI: 1.17- 1.99) and OS with HR 1.63 (95% CI:1.26-2.11) even after adjusting for SVI. Living in neighborhoods with high concentrations of racial and ethnic minorities increased odds of upstaging (OR 2.88, 95% CI: 0.99-8.37) in cT1a and was associated with PFS in cT3 (HR 2.45, 95% CI: 1.01-4.77). Compared to patients living in neighborhoods with SVI&amp;lt;25, patients with cT1a and cT2 tumor living in neighborhoods with SVI≥75 had about a 60% increased risk of mortality (OS HR 1.57, 95% CI: 1.01-2.45 for cT1b and HR 1.66, 95%CI:1.07-2.57 for cT2). Conclusion: These findings demonstrate that high neighborhood social vulnerability is associated with increased time to surgery and risk of progression and mortality. Impact: Neighborhood-level social vulnerability partly accounts for kidney cancer disparities in Arizona. Interventions need to focus on neighborhoods with high social vulnerability to improve care coordination for kidney cancer. Citation Format: Celina I. Valencia, Patrick Wightman, Kristin Morrill, Chiu-Hsieh Hsu, Hina Arif-Tiwari, Eric Kauffman, Francine C. Gachupin, Juan Chipollini, Benjamin R. Lee, Ken Batai. Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment in Arizona [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B079.

Sickle Cell Disease Births and Social Vulnerability (2016-2020): A Report from the Sickle Cell Data Collection Program

Introduction Despite national implementation of universal newborn screening for sickle cell disease (SCD) since 2006, data on the prevalence of SCD births in the United States are scarce. Updated prevalence data by geographic location are needed to guide the allocation of resources and to connect newborns to comprehensive SCD care. The purposes of this study were to describe the 1) crude and race-adjusted SCD birth prevalence and 2) crude SCD birth prevalence by quartiles of the social vulnerability index (SVI, CDC, 2020) in 11 Sickle Cell Data Collection (SCDC) program states (Alabama, California, Colorado, Georgia, Indiana, Michigan, Minnesota, North Carolina, Tennessee, Virginia, and Wisconsin). Methods This retrospective cohort study used newborn screening (NBS) records from 2016 to 2020. Births were included if they were confirmed SCD births and the mother's county of residence at the time of birth was in an SCDC state. Mother's county and newborn's race, ethnicity, sex, date of birth, and genotype were extracted from NBS records or birth certificates, if available. Crude SCD birth prevalence per 10,000 was calculated by dividing the cumulative number of SCD births by the cumulative number of all live births from 2016 to 2020 and multiplying by 10,000. Race-adjusted SCD birth prevalence was calculated by dividing the cumulative number of Black SCD births by live non-Hispanic Black (NHB) births from 2016 to 2020 and multiplying by 10,000. Frequency of all births and NHB births were obtained from each state's health department. County characteristics were quantified by the SVI using the 2020 state-ranked CDC/ATSDR SVI datasets (CDC, 2020) and were matched to mother's county of residence at birth. SVI ranks counties on 16 social factors, including unemployment, minority status, and disability. Ranks were grouped into SVI quartiles: low (0 ≤ SVI ≤ 0.25), medium (0.25 &amp;lt; SVI ≤ 0.5), high (0.5 &amp;lt; SVI ≤ 0.75) and very high (0.75 &amp;lt; SVI ≤ 1.0) vulnerability. Crude SCD birth prevalence was calculated for each SVI quartile. Results From 2016 through 2020, there were 3,305 newborns with SCD across 11 SCDC states [ 49.6% male, 89.8% Black]. Georgia had the highest number of births (n=758) followed by North Carolina (n=435), California (n=419), and Alabama (n=386). The majority (57.0%) had Hb SS or Hb S Beta 0 thalassemia, 27.9% had Hb SC, and 9.6 % had Hb S Beta + thalassemia or other SCD type. The crude SCD birth prevalence ranged from 1.22 to 13.22 per 10,000 live births. The race-adjusted SCD birth prevalence for SCDC states was 28.55 per 10,000 or 1 in every 350 NHB births. Race-adjusted birth prevalence varied among states ranging from 19.53 to 34.11 per 10,000 NHB births (Table 1). Overall, the majority (67%) of mothers of newborns with SCD resided in high or very high social vulnerability counties (Figure 1). Except for Colorado, where the highest crude SCD birth prevalence was among mothers residing in medium social vulnerability counties, the remaining 10 SCDC states had the highest prevalence among mothers residing in high or very high social vulnerability counties. Limitations include using the mother's reported race for all births to calculate race-adjusted birth prevalence. Additionally, because of missing data on ethnicity for SCD births, we used all Black SCD births, rather than non-Hispanic Black SCD births, to calculate the race-adjusted SCD birth prevalence. Despite the limitations, the study provides crude and race-adjusted SCD birth prevalence data from 11 states in the South, Midwest, and Western United States, covering an estimated one third of the SCD population in the United States. Furthermore, providing the crude prevalence of SCD births by SVI quartile adds valuable information on county-level characteristics that might influence health outcomes for newborns with SCD. Conclusions The race-adjusted birth prevalence for SCD remains stable from previous estimates at 1 in every 350 BNH births. The finding that most mothers of newborns with SCD reside in high and very high social vulnerability counties at the time of birth underscores the importance of assessing social determinants of health (SDOH) that may impact health outcomes for newborns with SCD. Findings from this report can be used to guide state- and county-level programs that address SDOH for people with SCD and have implication for clinicians who must incorporate screening for SDOH in their practice and refer families to community resources as needed.

1771. A Novel Approach to Distributing COVID-19 Oral Antivirals During a Public Health Emergency Using a Pharmacy Home Delivery Model in New York City, 2022

Abstract Background In December 2021, the oral antivirals (OAVs) nirmatrelvir/ritonavir and molnupiravir were authorized for the treatment of COVID-19 in high-risk patients. Initial supplies were limited and states designated pharmacies to receive OAVs from a weekly federal allocation. New York City (NYC) has nearly 3,000 pharmacies serving a diverse population across a large urban area. To ensure fair access to OAVs, the NYC Health Department partnered with an online pharmacy to provide rapid delivery to any NYC address. Here we describe characteristics of patients served and metrics used to evaluate the program as the pandemic and OAV access evolved in 2022. Methods The NYC partner pharmacy provided data on OAV prescriptions including patient age, sex, delivery zip code, and dates of prescription and delivery. These data were matched with the NYC Health Department’s COVID-19 surveillance data including positive lab reported cases, Citywide Immunization Registry, deaths, all-cause emergency department (ED) visits and hospital admissions. Descriptive statistics were calculated using R Statistical Software. Results A total of 48,947 OAV prescriptions were delivered in 2022, reaching 99.5% of residential zip codes, accounting for 17.5% of the OAVs dispensed in NYC. The median time from prescription receipt to delivery was 17 hours (IQR 6-24) with half (49%) of deliveries going to high social vulnerability zip codes. Of OAV recipients, most (58%) were female, with a median age of 56 years (IQR 39, 68) with 32% aged 65 years or older; 78% had received at least a primary vaccination series; 36% matched with a lab reported COVID-19 case; 5.5% had an ED visit and 0.8% were hospitalized in NYC for any cause within 30 days of prescription date. Conclusion The NYC antiviral delivery program provided broad and timely access to COVID OAVs, serving a significant proportion of patients in high social vulnerability neighborhoods and older adults at higher risk for severe outcomes. Of note, an increasing proportion of people receiving OAVs were not reported as cases to public health, which likely reflects the increasing use of home tests in 2022. Limitations include the lack of data on race/ethnicity, underlying medical conditions and for patients receiving OAVs through other pharmacies. Disclosures All Authors: No reported disclosures

Association of social vulnerability with receipt of hernia repair in Texas

BackgroundThe effect of social health determinants on hernia surgery receipt is unclear. We aimed to assess the association of the social vulnerability index with the likelihood of undergoing elective and emergency hernia repair in Texas. MethodsThis is a retrospective cohort analysis of the Texas Hospital Inpatient Discharge Public Use Data File and Texas Outpatient Surgical and Radiological Procedure Public Use Data File from 2016 to 2019. Patients ≥18 years old with inguinal or umbilical hernia were included. Social vulnerability index and urban/rural status were merged with the database at the county level. Patients were stratified based on social vulnerability index quartiles, with the lowest quartile (Q1) designated as low vulnerability, Q2 and Q3 as average, and Q4 as high vulnerability. Wilcoxon rank sum, t test, and χ2 analysis were used, as appropriate. The relative risk of undergoing surgery was calculated with subgroup sensitivity analysis. ResultsOf 234,843 patients assessed, 148,139 (63.1%) underwent surgery. Compared to patients with an average social vulnerability index, the low social vulnerability index group was 36% more likely to receive surgery (relative risk: 1.36, 95% CI 1.34–1.37), whereas the high social vulnerability index group was 14% less likely to receive surgery (relative risk: 0.86, 95% CI 0.85–0.86). This remained significant after stratifying for age, sex, insurance status, ethnicity, and urban/rural status (P < .05). For emergency admissions, there was no difference in receipt of surgery by social vulnerability index. ConclusionVulnerable patients are less likely to undergo elective surgical hernia repair, even after adjusting for demographics, insurance, and urbanicity. The social vulnerability index may be a useful indicator of social determinants of health barriers to hernia repair.

The influence of social and environmental determinants of health on hospitalizations for pediatric asthma

Background Asthma is the most common chronic disease of childhood, and has several social, environmental, and demographic factors potentially influential to its disease burden. This study sought to determine the influence of these factors on hospital admissions and readmissions for pediatric asthma. Methods This was a retrospective cohort study using data from the Indiana Network for Patient Care, a state-wide health information exchange in the United States. Study participants were children 2-18 years old admitted to the hospital with a respiratory diagnostic code between 2010 and 2021. Clinical variables were obtained from electronic health record data, and social and environmental determinants of health data were obtained from the Indiana Social Assets and Vulnerabilities Indicators using geocoding systems. Negative binomial models were used to examine community level social and environmental risk factors modifying the relationship between patient characteristics and the risk of asthma-related hospitalizations and 30-day readmissions. Results The study sample included 25,063 patients with an average follow-up of 9 (SD = 5) years. Of these, there were 17,816 asthma-related admissions. There were a total of 1,037 asthma-related 30-day readmissions, with an incidence rate of readmissions relative to total visits of 0.028 per person-year. A high social vulnerability index (SVI) was associated with an increased rate of hospital admissions (Proportion attributable ratio: 1.09, 95%CI (1.03,1.15), p < 0.05). No environmental determinants of health were significantly associated with hospitalization rate. Conclusion High SVI was significantly associated with increased risk of total hospital admissions for pediatric asthma.

Association between Individual versus Community-level Social Vulnerability and Neonatal Opioid Withdrawal Syndrome among Pregnant Individuals Receiving Buprenorphine for Opioid Use Disorder.

Individual patient-level measures of adverse social determinants of health are associated with neonatal opioid withdrawal syndrome (NOWS), but the relative impact of community-level adverse social determinants of health remains to be defined. We examined the association between community-level social vulnerability and NOWS among pregnant individuals receiving buprenorphine for opioid use disorder. We conducted a secondary analysis of an established cohort of pregnant individuals and their infants participating in a multidisciplinary prenatal/addiction care program from 2013 to 2021. Addresses were geocoded using ArcGIS and linked at the census tract to the Centers for Disease Control and Prevention 2018 Social Vulnerability Index (SVI), incorporating 15 census variables. The primary exposure was the SVI as a composite measure of community-level social vulnerability, and secondarily, individual scores for four thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). The primary outcome was a clinical diagnosis of NOWS defined as withdrawal requiring pharmacological treatment following buprenorphine exposure. Among 703 pregnant individuals receiving buprenorphine, 39.8% (280/703) of infants were diagnosed with NOWS. Among our patinets, those who were nulliparous, had post-traumatic stress disorder, a term birth (≥ 37 weeks) and had a male infant were more likely to have an infant diagnosed with NOWS. Individuals with and without an infant diagnosed with NOWS had similarly high community-level social vulnerability per composite SVI scores (mean [standard deviation]: 0.6 [0.4-0.7] vs. 0.6 [0.4-0.7], p = 0.2]. In adjusted analyses, SVI, as a composite measure as well as the four domains, was not associated with NOWS diagnosis. Among pregnant persons receiving buprenorphine enrolled in a multidisciplinary prenatal and addition care program, while individual risk factors that measure adverse social determinants of health were associated with an NOWS diagnosis in the infant, community-level social vulnerability as measured by the SVI was not associated with the outcome. · Community-level SVI was not associated with neonatal opioid use disorder.. · Certain individual risk factors were identified as being associated with NOWS.. · Homogeneity of composite SVI scores may have led to lack of significant findings..

Understanding Regional Patterns of Overdose Deaths Related to Opioids and Psychostimulants

Background As overdose rates increase for multiple substances, policymakers need to identify geographic patterns of substance-specific deaths. In this study, we describe county-level opioid and psychostimulant overdose patterns and how they correlate with county-level social vulnerability measures. Methods A cross-sectional observational study, we used nationwide 2016-2018 restricted access Centers for Disease Prevention and Control county-level mortality files for 1,024 counties. We estimated quartiles of opioid and psychostimulant overdose mortality and provided estimates of their association with county-level Social Vulnerability Index (SVI) percentile. Results There was high opioid and psychostimulant overdose mortality in the Middle Atlantic, South Atlantic, East North Central, and Mountain regions. The Central US had the lowest opioid and psychostimulant overdose mortality rates. Counties with higher SVI scores (i.e. higher social vulnerability) were significantly more likely to experience high opioid and high psychostimulant overdose (high-high) mortality. A 10-percentile increase in SVI score was associated with a 3.1 percentage point increase in the likelihood of being a high-high county (p < 0.001) in unadjusted models and a 1.5 percentage point increase (p < 0.05) in models adjusting for region. Conclusion Our results illustrated the heterogenous geographic distribution of the growing concurrent opioid and psychostimulant overdose crisis. The substantial regional variation we identified highlights the need for local data to guide policymaking and treatment planning. The association of opioid-psychostimulant overdose mortality with social vulnerability demonstrates the critical need in impacted counties for tailored treatment that addresses the complex medical and social needs of people who use both opioids and psychostimulants.

Evaluation of the COVID-19 Vaccination Campaign ¡Ándale! ¿Qué Esperas? in Latinx Communities in California, June 2021-May 2022.

The 12-month vaccination campaign ¡Ándale! ¿Qué Esperas? was launched to increase COVID-19 vaccination rates in Latinx populations in California by expanding community outreach. The objectives of this evaluation were to (1) determine predictors of vaccination rates and (2) identify barriers to vaccination and potential solutions. Five community partners in California serving Latinx populations with high social vulnerability participated in the ¡Ándale! ¿Qué Esperas? campaign. Community health workers were hired to deliver outreach (virtual, one-on-one, group based, and information dissemination), vaccinations, and supportive services. We collected data on outreach strategy used (method and location), number of vaccinations provided and reasons for delay, and number of times that supportive services were provided. We used regression models to assess significant predictors of vaccinations and supportive services. Community health workers (N = 146) hired from June 1, 2021, through May 31, 2022, performed outreach engagements (n = 6297) and supportive services (n = 313 796), resulting in 130 413 vaccinations and 28 660 vaccine appointments. The number of vaccinations administered was significantly higher at events in which supportive services were provided versus not provided (coefficient = 34.02; 95% CI, 3.34-64.68; P = .03). The odds ratio of supportive services was 3.67 (95% CI, 1.76-7.55) during virtual outreach and 2.95 (95% CI, 2.37-3.69) during one-on-one outreach (P < .001 for both) as compared with information dissemination encounters. Vaccination concerns were reported among 55.0% of vaccinated survey respondents (67.7%, vaccine confidence; 51.7%, access). Supportive services facilitate vaccinations, ease transportation and time barriers, and instill confidence among working-class racial and ethnic minority populations.

Association of County-Level Food Deserts and Food Swamps with Hepatopancreatobiliary Cancer Outcomes

BackgroundMalnutrition has been linked to the development of hepatopancreatobiliary (HPB) cancer. We sought to examine the association between food swamps and food deserts on surgical outcomes of patients with HPB cancer. MethodsPatients who underwent surgery for HPB cancer between 2014 and 2020 were identified from the Medicare Standard Analytic Files. Patient-level data were linked to the United States Department of Agriculture data on food swamps and deserts. Multivariable regression was performed to examine the association between the food environment and outcomes. ResultsAmong 53,426 patients, patients from the worse food environment were more likely to be Black, have a higher Charlson Comorbidity Index, and reside in areas with high social vulnerability. Following surgery, the overall incidence of textbook outcome (TO) was 41.6% (n = 22,220). Patients residing in the worse food environments less often achieved a TO versus individuals residing in the healthiest food environments (food swamp: 39.4% vs. 43.9%; food desert: 38.5% vs 42.2%; p < 0.05). On multivariable analysis, individuals residing in the poorest food environments were associated with lower odds of achieving TO compared with individuals living in healthiest food environments (food swamp: OR 0.83, 95%CI 0.75–0.92, food desert: OR 0.86, 95%CI 0.76–0.97; both p < 0.05). ConclusionThe surrounding food environment of patients may serve as a modifiable socio-demographic risk factor that contributes to disparities in surgical outcomes of HPB cancer.

Abstract 13865: Home Monitoring and Unanticipated Interstage Readmissions: Evaluating the Impact of Neighborhood Social Vulnerability

Introduction: Unanticipated interstage (IS) readmissions are common in infants with hypoplastic left heart syndrome (HLHS). Enrollment in our center’s Infant Single Ventricle Management and Monitoring Program (ISVMP) has been associated with increased readmission frequency. We examined the impact of neighborhood social vulnerability on the association of ISVMP with readmission frequency and cumulative readmission days. We hypothesized that greater social vulnerability was associated with greater risk for readmission. Methods: We performed a retrospective single-center cohort study comparing infants with HLHS enrolled in ISVMP (12/2010-12/2019) to historical controls (01/2007-11/2010). Outcomes were number of readmissions per IS days and cumulative IS readmission days. Neighborhood social vulnerability was measured by the Centers for Disease Control Social Vulnerability Index (SVI). High SVI signifies greater vulnerability. Negative binomial regression models were used to examine the association between ISVMP, SVI tertiles, and the outcomes. Models were adjusted for demographic, operative, and discharge characteristics. Results: We evaluated 328 infants with HLHS; 198 ISVMP infants and 128 historical controls. The association of ISVMP and IS readmissions strengthened as social vulnerability increased. ISVMP was not associated with IS readmissions in low SVI infants (IRR 1.55; 95% CI 0.94, 2.54). However, middle and high SVI infants enrolled in ISVMP were significantly more likely to be readmitted than their historical counterparts (middle SVI: IRR 1.67; 95% CI 1.01, 2.76; high SVI: IRR 2.14; 95% CI 1.33, 3.45). On stratified analysis, there was no relationship between SVI tertile and cumulative IS readmission days in the historical controls. However, in the ISVMP cohort, high SVI infants had 70% more cumulative readmission days compared to their middle SVI peers (IRR 1.69; 95% CI 1.11, 2.59). Conclusions: High social vulnerability infants with HLHS enrolled in ISVMP are at high risk for IS readmission compared to their historical, middle and low vulnerability peers. Future efforts should focus on understanding whether these findings are due to disparities in IS medical complexity, illness severity, or readmission criteria.

Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis.

Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated. We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use. Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources.

Neighborhood Social Vulnerability Impacts Quality of Life in Kidney Stone Patients.

This study aimed to investigate the association between social vulnerability, as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI), and the quality of life (QoL) of kidney stone patients using the validated Wisconsin Stone Quality of Life Questionnaire (WISQOL). A retrospective analysis was conducted on medical records of new urolithiasis patients who completed the WISQOL at the University of Rochester Medical Center kidney stone clinic. The primary outcome was WISQOL score, which was measured across multiple domains. SVI was used to assess social vulnerability. Neighborhoods with high SVI were defined by a threshold greater than or equal to the 75th percentile nationally. Demographic and clinical data were collected. Statistical analyses, including univariate tests and multivariate linear regression, were performed to evaluate the relationships between social vulnerability and disease-specific QoL. A total of 1718 patients were included in the study. One hundred five subjects (6.1%) were from neighborhoods of high social vulnerability. Patients residing in neighborhoods with high social vulnerability (SVI quartile) reported significantly lower QoL scores (69.1 vs 77.2; P = .001) and this persisted across all domains, including social impact (32.6 vs 35.1; P = .002), emotional impact (25.2 vs 27.5; P = .006), disease impact (28.5 vs 31.4; P = .001), and vitality (10.3 vs 11.2; P = .015). Younger age, female sex, and higher number of comorbidities were identified as independent predictors of lower QoL scores. However, non-White race and Latinx ethnicity did not exhibit a significant association with QoL scores. These findings highlight the negative impact of high social vulnerability on QoL, emphasizing the importance of considering socioeconomic factors in patient care. These results emphasize the need for targeted interventions to support vulnerable populations. While this study offers initial insights, further research is essential to corroborate these outcomes across larger and more diverse populations.

Awareness of the diagnosis, treatment, and control of diabetes mellitus in Brazil.

To estimate the proportions of awareness, treatment, and control of diabetes mellitus (DM) in the Brazilian adult population. This is a cross-sectional study, with data from a representative sample of the Brazilian population, taken from the National Health Survey(PNS 2014/2015). Outcomes were defined based on glycated hemoglobin (HbA1c) measurements, self-reported DM diagnosis, and use of hypoglycemic agents or insulin. The proportion of DM awareness, treatment, and control was estimated according to sociodemographic characteristics, health conditions, and access to health services, and their respective 95% confidence intervals. DM prevalence in the Brazilian population was of 8.6% (95%CI: 7.8-9.3): 68.2% (95%CI: 63.9-72.3) were aware of their diagnosis, 92.2% (95%CI: 88.6-94.7) of those who were aware were undergoing drug treatments, and, of these, 35.8% (95%CI: 30.5-41.6) had controlled HbA1c levels. The proportions of DM awareness, control, and treatment were lower in men aged 18 to 39 years, individuals with low education, without health insurance, and beneficiaries of the Bolsa Família program. Approximately one in ten Brazilians has DM. A little more than half of this population is aware of their diagnosis, a condition measured by HbA1c dosage and clinical diagnosis. Among those who know, the vast majority are undergoing drug treatments. However, less than half of these have their HbA1c levels controlled. Worse scenarios were found in subgroups with high social vulnerability.

Mortality from neglected tropical ciseases in Brazil in the 21st Century: Analysis of spatial and temporal trends and associated factorsMortalidad por enfermedades tropicales desatendidas en Brasil en el siglo XXI: análisis de tendencias espaciales y temporales y factores asociados

To analyze the spatial-temporal distribution and factors associated with mortality from neglected tropical diseases (NTDs) in Brazil from 2000 to 2019. We performed an ecological study to analyze NTD-related deaths recorded in the Ministry of Health Mortality Information System (SIM). For the temporal analysis, the joinpoint method was used. Spatial dependence was analyzed using global Moran and local Getis-Ord Gi* indices. Four non-spatial and spatial regression models were used to identify factors associated with mortality. The mean mortality rate from NTDs in Brazil during the study period was 3.32 deaths per 100 000 inhabitants, with the highest rate (8.68 deaths per 100 000 inhabitants) recorded in the Midwest. The most prevalent causes of death were Chagas disease (n = 94 781; 74.9%) and schistosomiasis (n = 10 271; 8.1%). There was a 1.24% reduction (95%CI = -1.6; -0.9; P < 0.001) in NTD-related mortality in Brazil per year. A high/high spatial distribution pattern and hotspots were observed in municipalities in the states of Goiás, Minas Gerais, Bahia, Tocantins, and Piauí. The indicators "population in households with density > 2 people per bedroom" (β = -0.07; P = 0.00) and "municipal human development index" (β = -3.36; P = 0.08) were negatively associated with the outcome, while the "index of social vulnerability" (β = 2.74; P = 0.05) was positively associated with the outcome. Lower human development and higher social vulnerability are associated with higher mortality from NTDs, which should guide NTD prevention and control efforts.

Impact of Social Vulnerability on Diabetes-Related Cardiovascular Mortality in the United States.

Background Social vulnerability impacts the natural history of diabetes as well as cardiovascular disease (CVD). However, there are little data regarding the social vulnerability association with diabetes-related CVD mortality. Methods and Results County-level mortality data (where CVD was the underlying cause of death with diabetes among the multiple causes) extracted from the Centers for Disease Control multiple cause of death (2015-2019) and the 2018 Social Vulnerability Index databases were aggregated into quartiles based on their Social Vulnerability Index ranking from the least (first quartile) to the most vulnerable (fourth quartile). Stratified by demographic groups, the data were analyzed for overall CVD, as well as for ischemic heart disease, hypertensive disease, heart failure, and cerebrovascular disease. In the 5-year study period, 387 139 crude diabetes-related cardiovascular mortality records were identified. The age-adjusted mortality rate for CVD was higher in the fourth quartile compared with the first quartile (relative risk [RR], 1.66 [95% CI, 1.64-1.67]) with an estimated 39 328 excess deaths. Among the youngest age group (<55 years), those with the highest social vulnerability had 2 to 4 times the rate of cardiovascular mortality compared with the first quartile: ischemic heart disease (RR, 2.07 [95% CI, 1.97-2.17]; heart failure (RR, 3.03 [95% CI, 2.62-3.52]); hypertensive disease (RR, 3.79 [95% CI, 3.45-4.17]; and cerebrovascular disease (RR, 4.39 [95% CI, 3.75-5.13]). Conclusions Counties with greater social vulnerability had higher diabetes-related CVD mortality, especially among younger adults. Targeted health policies that are designed to reduce these disparities are warranted.

Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019.

Social determinants of health and associated systems, policies, and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared with other racial/ethnic groups. In this study, we examined incidence rates of 3 types of gastrointestinal cancer among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and Social Vulnerability Index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000 population) for stomach, liver, and colorectal cancers were compared within NH-AI/AN populations and between the NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate- and high-SVI-score counties in Alaska, the Southern Plains, and the East than in low-SVI counties. Incidence rates among NH-AI/AN populations were elevated when compared with NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.

Social Vulnerability and the Prevalence of Opioid Use Disorder Among Older Medicare Beneficiaries in U.S. Counties.

Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less is about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC's social vulnerability index and other covariates. Using the total number of older beneficiaries with OUD as the dependent variable and the total number of older beneficiaries as the offset, we implement a series of nested negative binomial regression models and then analyze by social vulnerability quartiles. Higher social vulnerability is associated with higher prevalence of OUD in U.S. counties. This association cannot be fully explained by the differences in the characteristics of older Medicare beneficiaries (e.g., average age) and/or other social conditions (e.g., social capital) across counties. Moreover, the group comparison tests indicate correlates of the prevalence of OUD vary across social vulnerability quartiles in that the average number of mental disorders is positively related to OUD prevalence in the least and the most vulnerable counties and social capital benefits the less vulnerable counties. A perspective drawing upon contextual factors, especially social vulnerability, may be more effective in reducing OUD among older adults in U.S. counties than a one-size-fits-all approach.