Levels Of Social Vulnerability Research Articles

Disparities in access to care among patients with appendiceal or colorectal cancer and peritoneal metastases: A medicare insurance-based study in the United States.

Prior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM. Patients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone. Among 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38). An exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations.

The role of families in the response of inclusive schools: A case study from teacher’s perspectives

Some families identified as being at risk, including families of immigrant origin, demonstrate a lower degree of participation in school communities. This constitutes a major challenge for educational institutions. In this research, a case study including three public schools affected by school segregation was carried out. The aim was to analyze and disseminate teachers’ experiences and contributions around the question of family-school relationships, particularly measures they take to promote the participation of families in the daily life of schools. This included a particular focus on schools characterized by high degree of segregation and pupils with higher levels of social vulnerability. The study was carried out as a multi-local ethnographic project in three schools in the Basque Country, Spain, through participant observation, interviews, and focus groups with teachers, pupils, school leadership teams and psycho-pedagogical teams. The results obtained show that schools condition the participation of families, especially those most at risk, and that this has an impact on the socio-emotional development of children. They also highlight the importance of building communication and relationship channels between families and schools. In the current age of globalization, the need to create a network of collaborative and trusting relationships between families and teachers is more evident than ever. Only by these means can children be properly supported to achieve their maximum potential.

FACTORS ASSOCIATED WITH THE PERSON-CENTERED CLINICAL METHOD IN PRIMARY HEALTH CARE: A STUDY IN PORTO ALEGRE, BRAZIL

Background. The medical approach is influenced by several factors present at the patient, doctor, health service, society, and culture levels. Purpose. The purpose of this paper is to establish the degree of person-centeredness of care attributed by patients to the clinical approach of physicians from a primary health care (PHC) service and to ascertain its association with variables related to the care recipient. Methods. This cross-sectional study was conducted with a sample of patients (n = 408) with hypertension and/or diabetes treated at 12 health centers belonging to a PHC network in the city of Porto Alegre, Rio Grande do Sul, Brazil. The degree of person-centered clinical method (PCCM) orientation was measured by the “Patient Perception of Patient-Centeredness” (PPPC) questionnaire. Results. The variables “educational attainment” and “duration of follow-up with the same physician” were significantly associated with a higher prevalence of low overall PPPC scores (corresponding to higher patient centeredness) assigned to physicians by the patients (PR = 1.04, 95% CI = 1.02–1.06, p-value &lt; 0.001 and PR = 1.01, 95% CI = 1.00–1.02, p-value = 0.032, respectively). On the other hand, the variables “living alone” and “fair/poor/very poor self-perception of health” were significantly associated with a lower prevalence of person centeredness (PR = 0.83, 95% CI = 0.72–0.96, p-value = 0.011 and PR = 0.88, 95% CI = 0.77–1.00, p-value = 0.041, respectively). Conclusions. These findings demonstrate that clinical approaches to people with a high level of social vulnerability require improvement, and that the length of follow-up provided by one physician can be an indicator of the extent to which providers are able to deliver person-centered care.

Testicular torsion disparities in the pediatric population

BackgroundThere are disparate findings in the literature on the impact of race and insurance status on gonadal loss in testicular torsion. We sought to determine if race or levels of social vulnerability influence the rate of torsion or gonadal loss. MethodsRetrospective cross-sectional review between December 2017 and September 2019. Social vulnerability index was dichotomized using the 75th percentile. Primary outcome was the diagnosis of testicular torsion. Results515 patients were included. There was no difference in median age, torsion diagnosis, and orchiectomy rate between the two institutions. Black/African American patients were >3 times more likely than Caucasian patients to be diagnosed with TT when controlled for dichotomized SVI, insurance, and age (OR 3.39, 95% CI 1.74 - 6.61, p < 0.01). ConclusionBlack/African American children have an increased risk of testicular torsion. Despite these patients having higher levels of social vulnerability, it was not associated.

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.

Social vulnerability assessment of landslide disaster based on improved TOPSIS method: Case study of eleven small towns in China

• Constructing evaluation index system of social vulnerability of small towns in China. • Exploring the spatial differences of social vulnerability landslide disaster areas. • Risk perception and social structure are the two key factors of social vulnerability in landslide disaster areas. • It provides a case and method reference for structural and non-structural disaster prevention & mitigation.a. There are few studies on the social vulnerability of small towns in landslide disaster areas. The occurrence of geological disasters will directly threaten the local socioeconomic growth, it is particularly important to identify vulnerable areas and populations by using the social vulnerability index system. Eleven small towns of landslide areas after Wenchuan earthquake were taken as examples, based on 863 questionnaires and statistical data, this study established a new comprehensive evaluation index system of social vulnerability evaluation in landslide areas, and conducted quantitative evaluation by using the improved TOPSIS (Technique for Order Preference by Similarity to an Ideal Solution) model, the social vulnerability index was adopted to compare, classify and rank the social vulnerability levels in townships. The empirical results indicate that the social vulnerability showed the characteristics of regional heterogeneity, most towns showed a high or medium level of social vulnerability. Only Yingxiu showed a low level of social vulnerability, Shuimo presented the highest evaluation score of social vulnerability in eleven towns, the inter-group difference between these two towns is 0.286. Risk perception is an important factor affecting social vulnerability in landslide areas, involving disaster awareness, disaster cognitive approach, and community publicity. Additionally, social structure is another key factor affecting these areas based on the scores of the top three areas with the highest social vulnerability, including disaster prevention facilities, residents' income, and infrastructure accessibility. The index system can evaluate the social vulnerability scientifically in landslide areas, it can be used for urban disaster management and socioeconomic development in geological disaster areas.

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.

Disparities in Care Access to Liver-Directed Therapy Among Medicare Beneficiaries with Colorectal Cancer Liver Metastasis.

BackgroundLiver-directed therapies (LDT) are important components of the multidisciplinary care of patients with colorectal cancer liver metastases (CRCLM) that contribute to improved long-term outcomes. Factors associated with receipt of LDT are poorly understood.Patients and MethodsPatients > 65 years old diagnosed with CRCLM were identified within the Medicare Standard Analytic File (2013–2017). Patients with extrahepatic metastatic disease were excluded. Mixed-effects analyses were used to assess patient factors associated with the primary outcome of LDT, defined as hepatectomy, ablation, and/or hepatic artery infusion chemotherapy (HAIC), as well as the secondary outcome of hepatectomy.ResultsAmong 23,484 patients with isolated CRCLM, only 2004 (8.5%) received LDT, although resectability status could not be determined for the entire cohort. Among patients who received LDT, 61.7% underwent hepatectomy alone, 28.1% received ablation alone, 8.5% underwent hepatectomy and ablation, and 1.8% received HAIC either alone (0.8%) or in combination with hepatectomy and/or ablation (0.9%). Patient factors independently associated with lower odds of LDT included older age, female sex, Black race, greater comorbidity burden, higher social vulnerability index, primary rectal cancer, synchronous liver metastasis, and further distance from a high-volume liver surgery center (p < 0.05). Results were similar for receipt of hepatectomy.ConclusionsDespite the well-accepted role of LDT for CRCLM, only a small proportion of Medicare beneficiaries with CRCLM receive LDT. Increasing access to specialized centers with expertise in LDT, particularly for Black patients, female patients, and those with higher levels of social vulnerability or long travel distances, may improve outcomes for patients with CRCLM.

Measuring and Profiling Social Vulnerability to Natural Disaster in Indonesia in 2019

Nowadays, natural hazards are often seen from the nature perspective only. However, it is necessary to know not only about the hazards, but also the community resilience to prepare for, respond to, and recover from disasters based on the social characteristics which are called social vulnerability. This study provides the identification of social vulnerability to natural hazards condition and characterization of the dominant factors at the district level in Indonesia using secondary data. The principal component analysis (PCA) is used to reduce 13 district-level variables into 4 components that represents the driving factors of social vulnerability. The results of PCA are used to quantify the social vulnerability level of the districts in Indonesia using social vulnerability index (SoVI), followed by the deeper exploration of social vulnerability problem using K-Means Clustering. The SoVI and cluster results were mapped by using QGIS to identify the social vulnerability at districts level. The research shows that most districts in Indonesia are at a low-level vulnerability. The districts with low vulnerability are spread in the Sumatera and Kalimantan area. However, there are 43 Districts in Eastern Indonesia are in a high-level vulnerability. These districts also suffer many problems, such low sosioeconomic status. The results of this study support not only the previous social vulnerability studies but also the government as the policymakers by setting priority regions and allocating the policies according to main social vulnerability problem of each district, especially in the most vulnerable regions.

Centroid competitive learning approach for clustering and mapping the social vulnerability in Morocco

Over the last three decades, growing inequalities in countries have compounded the issues faced by society's most vulnerable populations. Students are facing the brunt of the effects in particular. A student's social vulnerability emerges as a result of the interaction of a variety of individual and environmental factors that accumulate over time. Poverty, material deprivation, and a lack of parental education can all have an impact on student assessment in school. Previous research has focused on the impact of psychological, cognitive, and physical functioning on children's education, ignoring students’ social vulnerability and its impact on educational achievements in developing countries. This paper aims to identify vulnerable regions that need attention and intervention by clustering Moroccan students based on their social vulnerability using an unsupervised competitive learning approach “Centroid neural network,” subsequently displaying the results in a choropleth map to visualize the results. For this purpose, we used the PISA dataset which contains the full set of responses from individual students focusing on specific information such as their parent’s backgrounds, socioeconomic position, and school conditions. Based on our current findings, we concluded that social vulnerability has a detrimental impact on students’ cognitive development. Moreover, the choropleth map shows that 'Beni Mellal-Khenifra' has the highest level of social vulnerability among all regions, besides "Marrakech-Safi" "Eddakhla-Oued Eddahab" and "Guelmim-Oued Noun" all of which have a high level of social vulnerability as well, urging academicians to incorporate resilience building into the design of policies in these regions in order to improve student’s educational 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.

The COVID-19 Pandemic and the Migrant Population for HIV Diagnosis and Care Follow-Up: They Are Left Behind.

The coronavirus 2019 (COVID-19) pandemic has posed numerous worldwide challenges. The level of social vulnerability of the migrant population is disproportionately higher than other populations. Recent reports have shown that the access to care for the migrant population (i.e., non-French nationality patients) were greatly impacted during this pandemic. Thus, we would like to highlight the significant impact of the COVID-19 pandemic on care follow-up in those migrant people infected with HIV who receive HIV care in France. Two groups of patients were defined: that is, patients with continuous care and patients with a loss of follow-up of at least one year during the COVID-19 pandemic. Among 672 HIV patients, 19 (2.7%) patients were lost to follow-up for at least one year during the COVID-19 pandemic. We found no significant difference for gender (p = 0.332) or age (p = 0.115) between the two groups. However, patients with a loss of follow-up were mainly migrants rather than from the other group (p < 0.001), and the same results were observed for the nation of birth (89.5% vs. 44%, p < 0.001). In our hospital, most of the patients who were living abroad but had HIV care in France before the COVID epidemic (mainly retired migrants) were lost to follow-up during the COVID-19 pandemic. To date, most of them have not resumed HIV care in France and we do not know their present situation. We can only observe that the COVID-19 pandemic has predominately disrupted the HIV care of migrant populations. Do not let them be left behind!

County-Level Social Vulnerability and Emergency Department Visits for Firearm Injuries - 10 U.S. Jurisdictions, January 1, 2018-December 31, 2021.

At least 100,000 persons in the United States experience a fatal or nonfatal firearm injury each year.* CDC examined rates of firearm injury emergency department (ED) visits by community social vulnerability using data from CDC's Firearm Injury Surveillance Through Emergency Rooms (FASTER) program.† ED visit data, shared with CDC's National Syndromic Surveillance Program (NSSP)§ during 2018-2021, were analyzed for 647 counties in 10 FASTER-funded jurisdictions.¶ County-level social vulnerability data were obtained from the 2018 Social Vulnerability Index (SVI).** Rates of ED visits for firearm injuries (number of firearm injury ED visits per 100,000 ED visits) were calculated across tertile levels of social vulnerability. Negative binomial regression models were used to estimate rate ratios (RRs) and associated 95% CIs comparing rates of ED visits across social vulnerability levels. During 2018-2021, compared with rates in counties with low overall social vulnerability, the firearm injury ED visit rate was 1.34 times as high in counties with medium social vulnerability and 1.80 times as high in counties with high social vulnerability. Similar patterns were observed for the SVI themes of socioeconomic status and housing type and transportation, but not for the themes of household composition and disability status or racial and ethnic minority status and language proficiency. More timely data†† on firearm injury ED visits by social vulnerability can help identify communities disproportionately experiencing elevated firearm injury rates. States and communities can use the best available evidence to implement comprehensive prevention strategies that address inequities in the social and structural conditions that contribute to risk for violence, including creating protective community environments, strengthening economic supports, and intervening to reduce harms and prevent future risk (e.g., with hospital-based violence intervention programs) (1,2).

Assessment of social vulnerability in areas exposed to multiple hazards: A case study of the Khuzestan Province, Iran

The inability of a system to plan for, respond to, and adapt to hazards and unfavorable occurrences can lead to social vulnerability. Managers and planners can use social vulnerability assessment to optimize budget allocation, devise mitigation measures, and prepare for disasters. The purpose of this study was to determine the social vulnerability to natural disasters in the counties in Khuzestan Province (southwest Iran). This was accomplished by using geographic information system (GIS) methods and multi-criteria decision-making procedures. Data on the vulnerability to four distinct types of hazards (floods, earthquakes, landslides, and dust storms) were gathered, and the counties were ranked using fifteen social vulnerability indicators. The findings indicated that earthquakes and landslides have had the greatest impact on the vulnerability of the northern and northeastern counties in the province. Floods and dust storms have a greater impact on central, western, and southern counties. Western and eastern counties have the highest levels of social vulnerability, while southern counties have the lowest. The findings can be applied to establish plans for reducing social vulnerability and strengthening resilience in the province. Additionally, the methodology employed in the research project can be used to analyze social vulnerability in other countries with similar situations.

Educational equity in vulnerable territories

This present article aimed to analyze the educational equity among state schools located in vulnerable territories in the city of Guarulhos. The analysis involves the final year of elementary and high school. The database used was formed by data from the School Performance Assessment System of the State of São Paulo (Saresp) and the São Paulo Social Vulnerability Index (IPVS). A quantitative approach was used, and the data set was examined using descriptive and variance analysis, with social vulnerability in the territories and the color/race of students as independent variables and the average of the Basic Education Development Index of the State of São Paulo (Idesp), performance level in Portuguese, Mathematics and school flow as dependent variables. The results in the analyzed teaching stages demonstrate the existence of variations and distances between the learning of students enrolled in schools with different levels of social vulnerability, interfering with the advancement of educational equity, with prejudice to students from schools with greater vulnerability.

Non-use of combination HIV prevention tools and its determinants among men who have sex with men living in France

ObjectivesThis study explores sexual HIV preventive behaviors of men who have sex with men (MSM), including the use of treatment as prevention (TasP) and PrEP, during their most recent anal intercourse (MRAI) with a casual partner. We especially look at factors associated with the non-use of these prevention tools during MRAI with a casual partner. Patients and methodsData were extracted from the cross-sectional online survey called ‘Rapport au sexe 2019’, conducted in France among MSM. We performed univariate analyses to describe respondents’ characteristics, and simple and multiple logistic regression models to investigate the associations between unprotected MRAI with a casual partner and personal characteristics and situational determinants. Statistical analyses were performed using Stata software version 15. ResultsAmong participants, 76.2% self-reported they were HIV-negative, 9.7% HIV-positive, and 14.1% were unaware of their HIV status. Condoms were the most common prevention tool used during MRAI. The use of TasP was reported by 29.1% of HIV-positive respondents and PrEP by 17.8% of HIV-negative respondents. The proportion of MSM who declared no prevention practice was significant (24.7%). A high level of social vulnerability was associated with unprotected anal intercourse in HIV-negative and unknown HIV status respondents. ConclusionsOur findings underline the existence of specific vulnerable groups at great risk of HIV infection. Prevention programs must be adapted to the entire MSM population in all its diversity by promoting the whole range of current prevention tools.

Social vulnerability, COVID-19 impact, and decision making among adults in a low-resource community

Socially vulnerable individuals, including those with greater exposure to adversity and social instability, are at greater risk for a variety of negative outcomes following exposure to public health crises. One hypothesized mechanism linking social vulnerability to poor health outcomes is delay discounting, the behavioral tendency to select smaller immediately available rewards relative to larger delayed rewards. However, little research has examined the impact of real-world disease outbreaks, such as the COVID-19 pandemic, on the relation between social vulnerability and delay discounting. This study examined whether the severity of COVID-19 impact moderated the association between social vulnerability and delay discounting in a diverse sample of 72 human adults (Mage = 42.4; 69% Black; 87% female) drawn from two low-resource urban areas. Contrary to hypotheses, results indicated that exposure to more severe COVID-19 impacts did not affect decision making among individuals with higher levels of social vulnerability. Conversely, findings suggest that individuals with lower levels of social vulnerability who reported more significant impacts of COVID-19 evidenced a greater tendency to select larger, delayed rewards relative to individuals with greater social vulnerability. Findings suggest the recent pandemic may influence the relation between social vulnerability and behavioral processes underlying health decision-making.

1210-P: Associations between HbA1c, Area Level Social Vulnerability, and Poor COVID-Outcomes

Background: HbA1c has been associated with COVID-poor outcomes in diabetic and non-diabetic populations, while patients living in census tracts with high levels of social vulnerability [measured using the CDC’s Social Vulnerability Index (SVI) ] have experienced poorer outcomes. Objective: To examine associations between HbA1c, area level social vulnerability and poor COVID outcomes in patients who tested positive for COVID and were captured in the electronic medical record (EMR) at a large academic institution in the Southeastern United States. Methods: HbA1c and SVI, collected up to 3 years prior to a positive COVID test, were extracted from the EMR. HbA1c and SVI were compared by poor outcome status [hospitalization, intensive care unit (ICU) admission, and mortality]. Bayesian logistic regression was used to examine associations between HbA1c [≤5.7%; 5.7%-&amp;lt;6.5%; and ≥6.5%], SVI [living in high SVI census tract vs low SVI tract] and each COVID outcome separately. Multivariable models were adjusted for sex, age, race, body mass index and diabetes status. Results presented as odds ratios (OR) and 95% confidence intervals (95% CI) . Results: N=3,7patients were identified [mean age: 54 years (SD 16.3) , 60% female, 47% Black]. Patients with HbA1c ≥ 6.5% and those living in a high SVI census tract were more likely to experience a poor COVID outcome (p’s&amp;lt;0.0001) . In multivariable models, patients with HbA1c ≥ 6.5% had higher odds of hospitalization (OR 1.79, 95% CI 1.44-2.22) ; ICU admission (OR 2.13, 95% CI 1.78-2.55) ; and mortality (OR 1.60, 95% CI 1.12-2.28) . Patients living in a high SVI census tract had higher odds of hospitalization (OR 2.47, 95% CI 1.94-3.15) ; ICU admission (OR 2.58, 95% CI 2.12-3.14) ; and mortality (OR 2.07, 95% CI 1.39-3.09) . Conclusion: HbA1c ≥6.5% and living in a census tract with high social vulnerability were independently associated with poor COVID-outcomes. Findings highlight the need to assess HbA1c and area level social determinants in the context of COVID. Disclosure C.R.Howell: None. L.Zhang: None. S.Williams: None. N.Yi: None. W.Garvey: Other Relationship; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Epitomee, JAZZ Pharmaceuticals, Novo Nordisk, Novo Nordisk, Pfizer Inc., Pfizer Inc. A.Cherrington: Consultant; Bayer AG, Other Relationship; Novo Nordisk. Funding This work was supported by funding from the National Institute on Minority Health and Health Disparities (U54MD008176) .

Quality of life and social vulnerability of older adults in the urban community: A cross-sectional study

We aimed to investigate the association between social vulnerability and the quality of life of older adults. A cross-sectional study was conducted with 805 older adults. Quality of life was measured using the WHOQOL-BREF and WHOQOLOLD instruments. Moreover, the older adults were evaluated according to the level of social vulnerability of the sector they live in. We found that older adults living with medium and high/very high social vulnerability had lower quality of life scores in the social relationships domain and the sensory skills facet compared to those with low social vulnerability. Those who lived in medium social vulnerability sectors had lower scores in the physical domain and in the past, present, and future activities facet. Translating these results into older adult care practice is in line with the new health paradigms that aim to overcome the current biological model of health care an moves toward the active aging approach.

Tree canopy, pediatric asthma, and social vulnerability: An ecological study in Connecticut

Despite a variety of health benefits associated with trees, previous findings on links between tree canopy and asthma have been mixed. Little is known about the association of tree canopy with asthma emergency department (ED) visits and hospitalizations at the neighborhood level. This study examines associations between tree canopy and pediatric asthma ED visit/hospitalization rates among the Connecticut population at the census tract level and investigates the moderating effect of social vulnerability on these associations. Using data of the combined pediatric asthma ED visits and hospitalizations (from 2010 to 2014), tree canopy coverage, and area-based social vulnerability, we applied multivariate negative binomial regression models, controlling for confounders including ozone and road density. Results show that every 10-percentage point increase in tree canopy cover was expected to bring a 4% decrease in asthma ED visit/hospitalization rates. Further, every 10-percentage point increase in social vulnerability index was associated with an 18% increase in asthma ED visit/hospitalization rates. We also found a nonlinear association, indicating a U-shape effect of tree canopy on pediatric asthma ED visit/hospitalization rates. The levels of social vulnerability moderated the association between the nonlinear effect of tree canopy and asthma ED visit/hospitalization rates (β = -5.629, p =.004). Findings suggests that tree canopy may help reduce pediatric asthma ED visits and hospitalizations. Particularly, the benefits of tree canopy in decreasing pediatric asthma ED visits and hospitalizations would be more effective in more socially vulnerable areas.