Social Vulnerability Research Articles

The potential dark side of remote work transformation: a social vulnerability and relational perspective

The global COVID-19 pandemic led many organizations and employees to abruptly adopt remote work. This remote work transformation has broadly encompassed individuals from a diverse range of backgrounds (e.g. ethnicity, gender) and job roles. A multi-level, conceptual model is developed that explores its potential dark side, particularly for women and ethnic minorities. Drawing on social vulnerability theory and the relational framework of diversity, this manuscript explores how disproportionate exposure to remote work, surveillance and disciplinary mechanisms, along with adverse job and wage loss, job insecurity, and psychological health impacts for women and ethnic minorities may potentially permeate their workplace interactions and stimulate interpersonal conflict. Moreover, this model incorporates these relationships within their broader social context, shaped by the legislative framework and shared cultural beliefs such as social difference codes. Nevertheless, this model elucidates how certain organizational approaches to diversity management can potentially alleviate these disproportionate outcomes. Theoretical implications, future research directions, and recommendations for policy and practice are highlighted.

Polycystic ovary syndrome underdiagnosis patterns by individual-level and spatial social vulnerability measures.

To use electronic health records (EHR) data at Boston Medical Center (BMC) to identify individual-level and spatial predictors of missed diagnosis, among those who meet diagnostic criteria for PCOS. The BMC Clinical Data Warehouse was used to source patients who presented between October 1, 2003 and September 30, 2015 for any of the following: androgen blood tests, hirsutism, evaluation of menstrual regularity, pelvic ultrasound for any reason, or PCOS. Algorithm PCOS cases were identified as those with International Classification of disease (ICD) codes for irregular menstruation and either an ICD code for hirsutism, elevated testosterone lab, or polycystic ovarian morphology as identified using natural language processing on pelvic ultrasounds. Logistic regression models were used to estimate odds ratios (ORs) of missed PCOS diagnosis by age, race/ethnicity, education, primary language, body mass index (BMI), insurance type and social vulnerability index (SVI) score. In the 2003-2015 BMC-EHR PCOS at-risk cohort (n=23,786), there were 1,199 physician-diagnosed PCOS cases and 730 algorithm PCOS cases. In logistic regression models controlling for age, year, education, and SVI scores, Black/African American patients were more likely to have missed a PCOS diagnosis (OR = 1.69 [95% CI, 1.28, 2.24]) compared to non-Hispanic White patients, and relying on Medicaid or charity for insurance was associated with an increased odds of missed diagnosis when compared to private insurance (OR = 1.90 [95% CI, 1.47, 2.46], OR = 1.90 [95% CI, 1.41, 2.56], respectively). Higher SVI scores were associated with increased odds of missed diagnosis in univariate models. We observed individual-level and spatial disparities within the PCOS diagnosis. Further research should explore drivers of disparities for earlier intervention.

Language and education in migration policy: the inter-state model

Regarding the various indications such as social, cultural, political, educational, and labor policies of the host country for family migration, the present study discussed the index of inclusivity in psychosocial and educational immigration policies. The study aimed to propose how social and educational vulnerabilities of migrants should be addressed. To achieve this, the study examined the current status (state) and potential improvements in psychosocial and educational migration policies in terms of inclusivity. A wide range of materials including articles, news reports, journal pieces, legal documents from Europe and North America, specifically the EU, were analyzed to provide a comprehensive view of the subject. The study also utilized Selinker's Interlanguage theory from Second Language Acquisition to compare with migration policy in answering research questions. Through dynamic review, thematic analysis, and qualitative research design, the study concluded that the index of inclusivity is evolving and should be implemented in various aspects of migration policy. As a result, a model for education in migration policy, named "The Inter-state Model," was proposed. This model aims to provide clarity on the role and support of migration policies for migrants, particularly vulnerable populations. / Keywords: moderate inclusive education, transmigration, assimilation, diversity, migration policy, inter- state migration model

COVID-19 Deaths and Minority Health Social Vulnerability, in the U.S., January 1, 2020 through June 24, 2023.

Health disparities, leading to worse health outcomes such as elevated COVID-19 mortality rates, are rooted in social and structural factors. These disparities notably impact individuals from lower socioeconomic backgrounds and more socially vulnerable areas. We analyzed the relationship between COVID-19 deaths and social vulnerability using the Minority Health Social Vulnerability Index (MHSVI). COVID-19 death data in the U.S. was obtained from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, where COVID-19 deaths were defined using the ICD-10 code U07.1. MHSVI composite scores were calculated for 3089 U.S. counties and categorized into social vulnerability quartiles, where values ranged from 0 (lowest vulnerability) to 1 (highest vulnerability). Negative binomial regression was employed to determine death rate ratios for each quartile within each theme. Finally, a multivariate negative binomial regression including all MHSVI sub-themes, excluding the overall index ranking, was used to assess the association between each theme and COVID-19 death rates independently. There were 1,134,272 COVID-19 deaths from January 1, 2020 through June 24, 2023. Adjusted rate ratios for COVID-19 deaths in the overall index ranking were 1.06 (95% CI 0.99-1.13), 1.14 (95% CI 1.06-1.22), and 1.41 (95% CI 1.31-1.52) for the second, third and fourth quartiles, respectively. Sub-themes of socioeconomic status (SES), household characteristics (HC), racial and ethnic minority status (REMS), housing type and transportation (HTT), and medical vulnerability (MV) revealed increasing death rates in higher vulnerability quartiles. The healthcare infrastructure and access (HIA) theme had decreasing death rate ratios of 0.74 (95% CI 0.71-0.78), 0.59 (95% CI 0.56-0.62), and 0.42 (95% CI 0.39-0.44) for the second, third, and fourth quartiles, respectively. Finally, the multivariate analysis showed that the HC, HTT, HIA, and MV themes were associated with COVID-19 deaths (P < 0.05). Counties that were identified as more socially vulnerable experienced higher death rates from COVID-19. These areas may need additional public health and social support during future pandemics.

Social vulnerability to food insecurity in Sub-Saharan Africa: exploring the connection between climate change, funeral rites and food insecurity in rural Ghana

ABSTRACT Climate Change and food security remain one of the topical issues discussed globally. In Ghana, the literature has reported on the effects of climate change on the food consumption patterns of many households due to low adaptive capacity and inefficient food production systems. In addition to climate change as a threat to food security, funeral rites also play a major role in household food insecurity. However, the link between climate change, funeral rites and food security as indices of social vulnerability has been less investigated. Using a qualitative-dominance approach to research with 8 key informant interviews, 4 focus group discussions (FGDs) and a questionnaire, the analysis revealed that climate change and funeral rites are critical determinants of food insecurity in the Kassena Nankana Municipality of the Upper East Region of Ghana. The results show that while climate change affects the food production systems, the poorly harvested farm produce and livestock are used for the funeral rites of the deceased’s household family. While being sensitive to the cultural aspects of the uses of farm produce and livestock for funeral rites, and given the prevailing climatic conditions, the study recommends the need for traditional authorities and households to consider holding less expensive funeral rites which do not expend future food needs and resources. Again, localised climate change adaptation strategies need to be developed by the Ministry of Food and Agriculture to support the activities of agriculture in the municipality which is widely known to be susceptible to climate change.

Application of a digital quality measure for cancer diagnosis in Epic Cosmos.

Missed and delayed cancer diagnoses are common, harmful, and often preventable. We previously validated a digital quality measure (dQM) of emergency presentation (EP) of lung cancer in 2 US health systems. This study aimed to apply the dQM to a new national electronic health record (EHR) database and examine demographic associations. We applied the dQM (emergency encounter followed by new lung cancer diagnosis within 30 days) to Epic Cosmos, a deidentified database covering 184 million US patients. We examined dQM associations with sociodemographic factors. The overall EP rate was 19.6%. EP rate was higher in Black vs White patients (24% vs 19%, P < .001) and patients with younger age, higher social vulnerability, lower-income ZIP code, and self-reported transport difficulties. We successfully applied a dQM based on cancer EP to the largest US EHR database. This dQM could be a marker for sociodemographic vulnerabilities in cancer diagnosis.

The Impact of Tocilizumab Coverage on Health Equity for Inpatients with COVID-19 in the USA: A Distributional Cost-Effectiveness Analysis.

We conducted a distributional cost-effectiveness analysis to evaluate how coverage of tocilizumab for inpatients with COVID-19 from 2021 to present impacted health equity in the USA. A published, payer-perspective, distributional cost-effectiveness analysis for inpatient COVID-19 treatments was adapted to include information on baseline health disparities across 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups), and county-level social vulnerability (5 geographic quintiles). The underlying cost-effectiveness analysis was updated to reflect patient characteristics at admission, standard of care outcomes, tocilizumab efficacy, and contemporary unit costs. The distributional cost-effectiveness analysis inputs for COVID-19 hospitalization and subgroup risk adjustments based on social vulnerability were derived from published estimates. Opportunity costs were estimated by converting total tocilizumab spend into quality-adjusted life-years (QALYs), distributed equally across subgroups. Tocilizumab treatment was cost effective across all subgroups. Treatment resulted in larger relative QALY gains in more socially vulnerable subgroups than less socially vulnerable subgroups, given higher hospitalization rates and inpatient mortality. Using an opportunity cost threshold of US$150,000/QALY and an Atkinson index of 11, tocilizumab was estimated to have improved social welfare by increasing population health (53,252 QALYs gained) and reducing existing overall US health inequalities by 0.003% since 2021. Use of tocilizumab for COVID-19 since 2021 increased population health while improving health equity, as more patients with lower baseline health were eligible for treatment and received larger relative health gains. Future equitable access to tocilizumab for inpatients with COVID-19 is expected to lead to continued increases in population health and reductions in disparities.

Social Vulnerability Index and Dental Caries in Children: An Exploratory Study.

This retrospective cross-sectional study evaluated the association between caries outcomes in a pediatric population visiting a dental clinic and the social vulnerability index, an area-based measure capturing 4 main social determinants of health: socioeconomic status, household composition/disability, minority status/language, and housing/transportation. The Centers for Disease Control Social Vulnerability Index (SVI) and electronic dental record data of children (0 to 18 y) reporting a caries diagnosis at the Children's Hospital Colorado in 2020 were extracted for 9,201 children. Logistic regressions were used to test the association between SVI and the presence or absence of dental caries, adjusting for age, sex, ethnicity, and race. Children with a caries diagnosis had a greater mean overall SVI percentile (62.0, standard deviation [SD] = 29.1) compared with patients without a caries diagnosis (59.1, SD = 29.8; P < 0.001). With each 10-point increase in the overall SVI percentile, having a caries diagnosis visit was 2.7% more likely compared with having a visit without a caries diagnosis (odds ratio [OR] 1.027, 95% confidence interval [CI] 1.012, 1.042; P = 0.0004). Those with an overall SVI percentile between 51 and 75 were 23% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.23, 95% CI 1.07, 1.42; P = 0.003), and those with a percentile >75 were 23.6% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.236, 95% CI 1.09, 1.40; P = 0.001). Children (0 to 18 y) living in socially vulnerable environments or areas were more likely to have a caries diagnosis at their dental exam. This study showed an association between social determinants of health demonstrating social vulnerability and dental caries in children. Ultimately, understanding upstream factors for children living in socially vulnerable areas could support policymakers in creating more effective policies to support socially vulnerable populations.

Telemedicine and Access to Elective Cholecystectomy for Socially Vulnerable Adults

Socially vulnerable patients with symptomatic cholelithiasis are more likely to face barriers to accessing surgical care. This barrier to access can lead to delays in treatment, the need for emergent cholecystectomy, and worse outcomes. To determine the effectiveness of telemedicine vs in-person surgical consultation on access to elective cholecystectomy in socially vulnerable populations and to evaluate the association of scheduling navigation with access to elective cholecystectomy in these populations. This pilot randomized clinical trial conducted in a single academic center enrolled 60 adults from February 1, 2023, to February 21, 2024, with 3-month follow-up of clinical outcomes. Data were also collected retrospectively on a comparison group of 32 patients referred from June 30 to December 29, 2022. Adults with social vulnerability, such as being non-White or Hispanic or having nonprivate insurance or low income, with a diagnosis of symptomatic cholelithiasis and referral for outpatient surgical consultation were included. All trial participants were randomized to the telemedicine or in-person surgical consultation group, and received professional scheduling navigation. The latter intervention was compared with a historical cohort without navigation assistance. The primary outcome was completion of outpatient surgical consultation. Secondary outcomes included receipt of treatment and operative urgency. The trial enrolled 60 participants (30 per arm). Their mean (SD) age was 48.2 (18.2) years, 50 (83.3%) were female, 2 (3.3%) were Asian, 39 (65.0%) were Black, 8 (13.3%) were Hispanic, 11 (18.3%) were White, and 41 (68.3%) had no private insurance. The historical patient cohort included 32 participants (mean [SD] age, 45.9 [3.2] years; 27 [84.4%] female; 3 [9.4%] Asian, 15 [46.9%] Black, 10 [31.3%] Hispanic, and 6 [18.8%] White; and 18 [56.3%] without private insurance). In total, 18 trial participants assigned to telemedicine (60.0%) completed surgical consultations compared with 23 trial participants assigned to in-person visits (76.7%; P = .17). For telemedicine participants who underwent cholecystectomy, 3 of 7 (42.9%) underwent emergent cholecystectomy compared with 0 of 14 (0%) participants with in-person consultations (P = .03). Of 30 trial participants who received scheduling navigation, 23 (76.7%) completed surgical consultations compared with 15 of 32 patients in the historical cohort who did not receive scheduling navigation (46.9%; P = .02). Of 14 trial participants who received scheduling navigation and cholecystectomy, no participants underwent emergent cholecystectomy compared with 4 of 16 (25.0%) participants in the historical cohort without scheduling navigation (P = .04). In this pilot randomized clinical trial of socially vulnerable adults with symptomatic cholelithiasis, telemedicine consultation compared with in-person visits did not improve access to elective outpatient surgical care. However, scheduling navigation services may improve access to elective outpatient surgical care. Future large-scale studies are needed to identify possible barriers to virtual health care and mechanisms to address inequities. ClincialTrials.gov Identifier: NCT05745077.

Last defense in climate change: Assessing healthcare inequities in response to compound environmental risk in a megacity in Northern China

The compound risk of extreme heat and air pollution in the context of climate change has become an important challenge for megacities in Northern China. Severe spatial differences exist in healthcare facilities, which are the last defense to protect the health of residents. Understanding the match between compound risks and healthcare services is important for ensuring the basic well-being of residents. We selected 255 census units in Tianjin to comprehensively assess the healthcare services and risks of hazards, exposures, and social vulnerabilities in order to explore the match between risks and services. We quantified and graded environmental quality on a 5-point scale and investigated inequalities in risk-service relationships across different regions using correlation analysis, analysis of variance (ANOVA), and LISA. The results showed that: (1) the level of compound risk and the variability of risk increased with environmental degradation, main urban areas exhibited the highest level of risk, while suburban and district centralized construction areas demonstrated significant variability in risk; (2) the relationship was significantly imbalanced between healthcare services and risk in suburban and peripheral districts and counties, while the main urban areas and rural areas showed high and low levels of matching respectively; and (3) blue-green spaces could effectively alleviate the pressure on healthcare services in the main urban area and rural area. The results obtained in this study provide references for healthcare allocation strategies in areas with different degrees of environmental degradation, and we call for further planning of healthcare facilities in megacities to enhance their ability to adapt to climate change risks.

Assessing social equity of federal disaster aid distribution: A nationwide analysis.

In this study, we conduct the first comprehensive, nationwide assessment of social equity performance of multiple federal post- and pre-disaster assistance programs that differ in targeted recipients, project types, forms of aid, and funding requirements. We draw on the social equity and distributive justice theory to develop and test a set of hypotheses on the influence of program design and specificity on their aid distributional patterns and equity performance. The analysis uses panel data of about 3000 US counties to examine the relationship between a county's receipt of federal assistance and its recent disaster damage, socioeconomic, demographic, political, local government, and geographic characteristics in a two-stage random effects Tobit model. Expectedly, we find that post-disaster grants are largely driven by recent disaster damage, while damage is simultaneously influenced by local socioeconomic conditions. For all disaster programs, disproportionately more federal aid is allocated to populous counties. For programs geared toward state and local governments and targeting community recovery and mitigation, more aid is received by counties with better socioeconomic conditions. Conversely, for programs targeting individual relief and recovery, more aid is given to counties with lower incomes and greater social vulnerability. Results also indicate that counties located in high-risk regions receive greater outlays. These findings shed light on the varying degrees of social equity of federal disaster assistance programs tied to their cost-share requirement, funding caps, and inherent complexity of application procedures.

Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018.

Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States. This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability. Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed. We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

Unpacking “Social Vulnerability” and “Equity”: Critical Insights From Stormwater Climate Adaptation Research in the US Gulf Coast

AbstractThis paper assesses how the concepts of social vulnerability and equity are discursively constructed in co‐production research settings with a co‐created decision support tool. The data was collected during workshops (32 communities represented) and interviews (24 communities represented) with stormwater managers and stakeholders (SMS) working in small cities, counties/parishes, and villages and towns within 100 miles of the US Gulf Coast. Findings from participant observation of workshops show that SMS express similar viewpoints regarding indicators of social vulnerability to climate‐related hazards, often defining vulnerable people as less physically mobile or as having few monetary resources. Individuals articulated “community” through a lens of homeownership and often described their relationship to residents as strained. Findings from interviews reveal divergent viewpoints on the imperative and rationale for integrating social vulnerability data into stormwater assessments and planning. Interviews also generated more critical reflection than was present in workshops regarding racial disparities in flood hazard exposure. A key insight from this article is that tools and team composition matter but there is nuance in the degree to which they matter considering a range of contextual factors. The article argues that co‐production teams must plan for alternatives and different scenarios given the messiness of co‐production in practice and that research is needed to reveal the conditions under which specific tools matter for equity in terms of both process and outcomes.

Green spaces and flood vulnerability in urbanising regions: a case study in the Philadelphia metropolitan area

ABSTRACT Flooding continues to be one of the most significant natural hazards, disproportionately impacting vulnerable populations in urbanising regions. This study aims to examine the relationship between green space density and flood vulnerability in the Philadelphia Metropolitan Area by integrating social and geophysical data. The research focuses on identifying areas where high flood vulnerability coincides with low green space availability, as these are critical regions for targeted intervention. Using social vulnerability indicators such as income, age, and housing characteristics, combined with geophysical factors like soil permeability and drainage density, the study assesses flood vulnerability across census block groups. Local Indicators of Spatial Association (LISA) and discriminant analysis were employed to detect spatial clusters with elevated flood risks and low green space density. Results reveal that these high-risk clusters are concentrated in densely urbanised areas such as Norristown, where lower-income and elderly populations are overrepresented. These findings reinforce broader environmental justice concerns, as socially vulnerable communities face compounded risks from both inadequate flood protection and limited access to green spaces. The study emphasises the need for integrated flood management, combining green infrastructure with structural interventions, to guide urban planners and policymakers in reducing flood risks and promoting environmental equity.

Viral ecologies: Resurgent nature, COVID-19 and the discourse of transgender contagion

During the early days of the COVID-19 pandemic, popular narratives of a ‘resurgent nature’ and portrayals of the virus as a form of ‘revenge’ prompted geographical reflection on the promises and limitations of ecological perspectives on the SARS-CoV-2 virus. Revisiting these reflections in the light of what we have learned from the pandemic, this article asks what is to be gained by attempting to think critically with the virus about human space as multispecies composition. Thinking ecologically with the virus can become a method for critically reconsidering naturalised and dualistic orders of exclusion and inclusion, health and unhealth, or belonging and unbelonging. Specifically, we focus in this article on the overlap of immunological and trans-antagonistic discourses with viral imaginaries of the pandemic, exploring the paradox of vulnerability that arises at this point of intersection. COVID-19 simultaneously highlights humans’ mutual vulnerability as a horizontalising force and amplifies differential social vulnerabilities. In examining this paradox of vulnerability as it relates to viral discursive constructions of transness, we explore tensions between different modes of engaging, identifying and thinking with the virus in recognition that the social and the ecological cannot properly be considered as separate domains. The aim is not simply to propose an extended epidemiology that takes into account the complex human–nonhuman entanglement, but to explore the social, cultural and political implications of pandemic vulnerabilities and of thinking ecologically with the virus. We trace the shared conceptual underpinnings of ecological and immunological thought, showing that these same conceptual lineages manifest in political responses to the COVID-19 pandemic and exploring how they are expressed in queer- and trans-antagonistic discourse and policy. Building on these analyses, we develop a proposal for ‘transing’ the virus and a model for ‘thinking ecologically’ that is simultaneously liberatory, messy and agnostic.

8361 Impact of Social Vulnerability on Glycemic Control in Primary Care Patients with Diabetes

Abstract Disclosure: J.N. Tich: None. S.R. MacLeod: None. V. Zhang: None. T. Love: None. R.J. Fortuna: None. Introduction: According to the CDC, 29.7 million Americans are diagnosed with diabetes (DM), contributing to morbidity, mortality and strain on the healthcare system. The impact of social determinants of health (SDOH) and social vulnerability (SV), as measured by the social vulnerability index (SVI), on DM care and control is evident. In populations with lower educational attainment levels, lower income and higher rates of poverty, prevalence of DM and rates of complications are higher. However, less is understood about how the intersectionality between SDOH/SV and race impacts diabetes control. Aims: We sought to examine the impact of SV and race on DM control in primary care patients in Upstate NY. Methods: We examined 26,010 patients with DM in Upstate NY. We defined DM control based on national HEDIS standards. SVI were calculated for each patient based on census track data. The SVI is calculated based on 16 variables in four themes: socioeconomic status, household characteristics, racial/ethnic minority status, and housing/transportation. SVI scores range from 0 (lowest vulnerability) to 1 (highest vulnerability). In addition to calculated SVI scores, we examined patient-reported SDOH, including food insecurity, housing insecurity, transportation, and social isolation. Race and ethnicity related parameters were self-reported. We report preliminary descriptive data. Results: Overall, 73.6% of patients were controlled with a HgA1c &amp;lt;8% based on the HEDIS definition. Control rates varied based on race (white 75.9% Black 66.1%; Asian 73.7%; other race 66.6%), calculated SVI, and patient reported SDOH. Within each racial category, diabetes control rates worsened with increasing SVI. Patients who expressed food insecurity had lower rates of DM control than those who had no food insecurity (68.8% vs 79.7%). Similarly, patients with housing insecurity had lower control rates (67.5%) compared to those who had greater housing security (80.0%). Patients with unmet transportation needs had lower rates of diabetic control (67.4%) compared to those with stable transportation (80.6%). Additional statistical tests and multivariate regression models are pending. Conclusions: Across a large sample of patients with diabetes, increasing SV was associated with worsening glycemic control across all racial groups studied. In preliminary analyses, both race and SVI appear to be independently associated with DM control. SVI did not fully mitigate the influence of rate on DM control. Within same SVI category, non-white participants appeared to have a more negative impact on DM control compared to white participants. While SDOH are well known influences, these findings specifically demonstrate the link between SV and glycemic control, highlighting the fact that at the same SVI quartile, non-white participants may be more vulnerable to dysglycemia. Presentation: 6/2/2024 6/2/2024

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

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

Community-Level Social Vulnerability and Hip and Knee Joint Replacement Surgery Receipt Among Medicare Enrollees With Arthritis.

(1) Explore associations between county minority health social vulnerability index (MH-SVI) and total joint replacement (TJR), and (2) assess associations by individual-level race/ethnicity. An expanded understanding of relevant social determinants of health is essential to inform policies and practices that promote equitable access to hip and knee TJR. Retrospective cohort study of Medicare enrollees. Centers for Medicare and Medicaid Services claims data were linked with MH-SVI. Multivariable logistic regression models were used to evaluate the odds of TJR according to the MH-SVI quartile in which enrollees resided. A total of 10,471,413 traditional Medicare enrollees in 2018 aged 67 years or older with arthritis. The main outcome was enrollee primary TJR during hospitalization. The main exposure was the MH-SVI (composite and 6 themes) for the county of enrollee residence. Results were stratified by enrollee race/ethnicity. Asian American, Native Hawaiian, or Pacific Islander (AANHPI), Black or African American (Black), and Hispanic enrollees comparatively had 26%-41% lower odds of receiving TJR than White enrollees. Residing in counties within the highest quartile of composite and socioeconomic status vulnerability measures were associated with lower TJR overall and by race/ethnicity. Residing in counties with increased medical vulnerability for Black and White enrollees, housing type and transportation vulnerability for AANHPI and Hispanic enrollees, minority status and language theme for AANHPI enrollees, and household composition vulnerability for White enrollees were also associated with lower TJR. Higher levels of social vulnerability were associated with lower TJR. However, the association varied by individual race/ethnicity. Implementing multisectoral strategies is crucial for ensuring equitable access to care.

Context matters when evacuating large cities: Shifting the focus from individual characteristics to location and social vulnerability

Climate change is driving extreme weather, heat and flooding, which increasingly require evacuations. Recent studies have found inconclusive results on the determinants of evacuation-related decisions and have reported widely varying evacuation rates, especially in high-density areas. We use a large dataset of geotagged evacuation choices in Paris, France (n = 2976) during a flood, to show that while they are rarely addressed, location, social vulnerability, length of residence, and hazard exposure are critical predictors. They can be used to infer the impact of previous experience on evacuation intentions, which is usually difficult to collect at scales relevant to decision-making. We address multiple evacuation choices over time that have previously been overlooked, including gradually self-fueling spontaneous evacuations after observations of peers evacuating or flooding proximity and post-impact evacuation due to infrastructure disruption. Our findings reveal that many people wait until their home is flooded to evacuate. The gap between the initial share of people leaving immediately and the minority refusing to leave in any case even after their housing is flooded gradually fills when considering different evacuation behaviors over time. Such chronology might explain the wide range of evacuation rates reported in the literature. However, people in vulnerable situations and with increased hazard exposure are more likely to declare that they would disregard evacuation instructions. One key implication is that policies aimed at reducing social vulnerability might be more effective than communication campaigns to increase preparedness and support evacuation.

Examining Local Government’s Web-Based Climate Risk Transparency in Florida

The article draws from institutional and social vulnerability theories and examines the determinants of climate risk transparency by local governments. Using data from Florida cities, the study investigates the impact of membership in climate networks and local socioeconomic and sociodemographic factors on web-based climate risk transparency. The findings support the view that membership in climate compact organizations, such as the International Council of Local Environmental Initiatives (ICLEI) and Southeast Florida Regional Climate Compact (SEFRCC), serve as institutional factors that lead to climate risk disclosures and contribute to improved adaptive governance and transparency. It also shows that college education, which likely enhances individuals’ ability to search for, interpret, and use information regarding climate risk, contributes to the decision to disclose information. Lastly, it reveals that bigger cities are more likely to disclose climate risk to mitigate these threats because disasters in large urban centers affect businesses and commuters and cause more significant damage than in smaller towns.