Ignoring workplace exposures that occur beyond the local residential context in place-based risk indices like the CDC\'s Social Vulnerability Index (SVI) likely misclassifies community exposure by under-counting risks and obscuring true drivers of racial/ethnic health disparities. To investigate this hypothesis, we developed several place-based indicators of occupational exposure and examined their relationships with race/ethnicity, SVI, and health inequities. We used publicly available job exposure matrices and employment estimates from the United States (US) Census to create and map six indicators of occupational hazards for every census tract in the US. We characterized census tracts with high workplace-low SVI scores. We used natural cubic splines to examine tract level associations between the percentage of racial/ethnic minorities (individuals who are not non-Hispanic White) and the occupational indicators. Lastly, we stratified each census tract into high/low occupational noise, chemical pollutant, and disease/infection exposure to examine racial/ethnic health disparities to diabetes, asthma, and high blood pressure, respectively, as a consequence of occupational exposure inequities. Our results show that racial/ethnic minority communities, particularly those that are also low-income, experience a disproportionate burden of workplace exposures that may be contributing to racial/ethnic health disparities. When composite risk measures, such as SVI, are calculated using only information from the local residential neighborhood, they may systematically under-count occupational risks experienced by the most vulnerable communities. There is a need to consider the role of occupational justice on nationwide, racial/ethnic health disparities.

BACKGROUND: Alcohol related liver disease (ALD) affects diverse communities with individual and social characteristics that can impact outcomes. The Social Vulnerability Index (SVI) assigns a score between 0 and 1, where higher scores represent an increased risk of social vulnerability. We sought to assess the impact of SVI on outcomes of patients hospitalized with ALD with access to social support services.
METHODS: Hospitalizations for ALD at our institution between March and August 2019 were reviewed. All patients were assigned an SVI score based on their residential census tract. Per our standard practice, patients were screened by care coordinators to identify needs for rehabilitation counseling, and care coordination after discharge. Demographics, hepatic decompensation, critical care needs, readmission, and mortality were compared.
RESULTS: Among 73 patients admitted for alcoholic hepatitis, 32 had a low SVI and 42 had a high SVI. African American patients were more likely to have a higher SVI (35% vs 0%, p=<0.001). No significant difference in outcomes based on SVI was noted. There were 393 patients admitted for alcoholic cirrhosis including 166 with a low SVI and 227 with a high SVI. Patients that were African American (23.6% vs 5.5%, p=<0.001) or disabled (41.4% vs 29.5%, p=0.008) had a higher SVI. No significant difference in outcomes based on SVI was noted.
CONCLUSIONS: Most patients admitted for ALD had a high SVI; however, SVI did not impact hospitalization outcomes.

In the southwestern United States, the frequency of summer wildfires has elevated ambient PM2.5 concentrations and rates of adverse birth outcomes. Notably, hypertensive disorders in pregnancy (HDP) constitute a significant determinant associated with maternal mortality and adverse birth outcomes. Despite the accumulating body of evidence, scant research has delved into the correlation between chemical components of wildfire PM2.5 and the risk of HDP. Derived from data provided by the National Center for Health Statistics, singleton births from >2.68 million pregnant women were selected across 8 states (Arizona, AZ; California, CA, Idaho, ID, Montana, MT; Nevada, NV; Oregon, OR; Utah, UT, and Wyoming, WY) in the southwestern US from 2001 to 2004. A spatiotemporal model and a Goddard Earth Observing System chemical transport model were employed to forecast daily concentrations of total and wildfire PM2.5-derived exposure. Various modeling techniques including unadjusted analyses, covariate-adjusted models, propensity-score matching, and double robust typical logit models were applied to assess the relationship between wildfire PM2.5 exposure and gestational hypertension and eclampsia. Exposure to fire PM2.5, fire-sourced black carbon (BC) and organic carbon (OC) were associated with an augmented risk of gestational hypertension (ORPM2.5 = 1.125, 95 % CI: 1.109,1.141; ORBC = 1.247, 95 % CI: 1.214,1.281; OROC = 1.153, 95 % CI: 1.132, 1.174) and eclampsia (ORPM2.5 = 1.217, 95 % CI: 1.145,1.293; ORBC = 1.458, 95 % CI: 1.291,1.646; OROC = 1.309, 95 % CI: 1.208,1.418) during the pregnancy exposure window with the strongest effect. The associations were stronger that the observed effects of ambient PM2.5 in which the sources primarily came from urban emissions. Social vulnerability index (SVI), education years, pre-pregnancy diabetes, and hypertension acted as effect modifiers. Gestational exposure to wildfire PM2.5 and specific chemical components (BC and OC) increased gestational hypertension and eclampsia risk in the southwestern United States.

UNASSIGNED: Despite being the second leading cause of death in the United States, cancer disproportionately affects underserved communities due to multiple social factors like economic instability and limited healthcare access, leading to worse survival outcomes. This cross-sectional database study involves real-world data to explore the relationship between the Social Vulnerability Index (SVI), a measure of community resilience to disasters, and disparities in screening, incidence, and mortality rates of breast, colorectal, and lung cancer. The SVI encompasses four themes: socioeconomic status, household composition & disability, minority status & language, and housing type & transportation.
UNASSIGNED: Using county-level data, this study compared cancer metrics in U.S. counties and the impact of high and low SVI. Two-sided statistical analysis was performed to compare SVI tertiles and cancer screening, incidence, and mortality rates. The outcomes were analyzed with logistic regression to determine the odds ratio of SVI counties having cancer metrics at or above the median.
UNASSIGNED: Our study encompassed 3,132 United States counties. From publicly available SVI data, we demonstrated that high SVI scores correlate with low breast and colorectal cancer screening rates, along with high incidence and mortality rates for all three types of cancers. County level SVI has impact on incidence rates of cancers; breast cancer rates were lowest in high SVI counties, while colorectal and lung cancer rates were highest in the same counties. Age-adjusted mortality rates for all three cancers increased across SVI tertiles. After risk adjustment, a 10-point SVI increase correlated with lower screening and higher mortality rates.
UNASSIGNED: In conclusion, our study establishes a significant correlation between SVI and cancer metrics, highlighting the potential to identify marginalized communities with health disparities for targeted healthcare initiatives. It underscores the need for further longitudinal studies on bridging the gap in overall cancer care in the United States.

OBJECTIVE: There are limited data on how neighborhood-level risk factors affect the likelihood of having prenatal diagnosis. Neighborhood social vulnerability can be quantified and ranked using the social vulnerability index (SVI), a tool that measures the cumulative effect of external stressors in the local environment that may affect health outcomes. The objective of the study was to determine the relationship between SVI and prenatal diagnosis among pregnant patients who received genetic counseling.
METHODS: Retrospective cohort study of all pregnant patients who had genetic counseling at two hospitals in New York between January 2019 and December 2022. For each patient, the address of residence was linked to an SVI score (primary exposure) based on census tract. SVI scores were subdivided into fifths and analyzed categorically. The primary outcome was prenatal diagnosis (yes/no). Multivariable logistic regression was performed.
RESULTS: A total of 5,935 patients were included for analysis and 231 (3.9 %) had prenatal diagnosis. On regression analysis, no association between SVI and prenatal diagnosis was observed. Patients who had a diagnostic procedure were more likely to be English speaking (aOR 1.80; 95 % CI 1.13-2.87), carriers of a genetic disorder (aOR 1.94; 95 % CI 1.32-2.86), had increased NT (aOR 6.89; 95 % CI 3.65-13.00), abnormal NIPS (aOR 9.58; 95 % CI 5.81-15.80), or had fetal structural anomalies (aOR 10.60; 95 % CI 6.62-16.96). No differences were seen based on race and ethnicity group, insurance type, or marital status.
CONCLUSIONS: SVI score does not affect rate of prenatal diagnosis. Findings may differ in other geographic regions and populations.

BACKGROUND: COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups.
OBJECTIVE: We developed a social vulnerability index (SVI) to predict individuals\' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022.
METHODS: In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries\' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals\' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index.
RESULTS: In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions.
CONCLUSIONS: In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups.

OBJECTIVE: We explored the associations between socioeconomic status, as evaluated by the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI), and characteristics of open globe injury (OGI) in a Level I trauma center during the COVID-19 pandemic.
METHODS: Retrospective review of electronic medical records of patients who underwent OGI evaluation and repair at Harborview Medical Center between March/2017 and March/2021. Demographic data and patient characteristics were recorded. The SVI was obtained based on the patient\'s home address. Patients were grouped into the \"historical\" (pre-COVID) cohort, including dates from March 2017 - March 2020, and the \"COVID\" cohort, including dates from March 2020 - March 2021.
RESULTS: 318 patients (77.4% male) were included. Average ± S.D. age (years) and SVI scores were 44.7 ± 22.7 and 0.413 ± 0.195, respectively. SVI scores were significantly higher (more vulnerable) during the COVID-19 pandemic compared to years prior (p = 0.017), however when compared to scores for the same patients prior to the pandemic, no difference was found (p = 0.609). There was no significant difference between intentional and non-intentional trauma, work-related injuries, OGI type, presence of endophthalmitis, or ocular trauma score (p ≥ 0.293). Still, significantly fewer motor vehicle-associated (MVA) OGIs occurred during the pandemic (p = 0.041).
CONCLUSIONS: Patients with OGI during the COVID-19 pandemic had higher SVI scores, however when considering the overall effect of the pandemic, our findings are likely reflective of the societal changes at large. There was no identifiable impact on the mechanisms or characteristics of ocular injuries, except for fewer MVA injuries.

UNASSIGNED: Social vulnerability index (SVI) estimates the vulnerability of communities to disasters, encompassing 4 separate domains (socioeconomic, household composition and disability, minority status and language, and housing and transportation). The SVI has been linked with risk and outcomes of cardiovascular disease (CVD).
UNASSIGNED: This scoping review explored the literature between the SVI and CVD continuum, with a goal to identify gaps in understanding the impact of the SVI on CVD and to elucidate future research opportunities.
UNASSIGNED: We systematically searched 7 databases from inception to May 19, 2023, for articles that explored the relationship between the SVI and CVD care continuum, including prevention, diagnosis and prevalence, treatment, and health outcomes. Extracted data included SVI ranking type, populations, outcomes, and quality of studies.
UNASSIGNED: Twelve studies evaluated the impact of SVI on the CVD continuum. Five studies explored mortality outcomes, 3 studies explored CVD risk factor prevalence, 4 studies explored CVD prevalence, 1 study explored access to health care in those with CVD, 1 study explored the use of cardiac rehabilitation services, and 1 study explored heart failure readmission rates, all of which revealed statistically significant associations with SVI. All studies included the SVI aggregate percentile ranking, while 5 studies focused on individual thematic components. We identified gaps in understanding the SVI\'s impact on CVD care continuum, particularly regarding CVD prevention and early detection.
UNASSIGNED: This review provides a comprehensive understanding of the SVI\'s application in assessing various aspects of the CVD care continuum and highlights potential avenues for future research.

OBJECTIVE: This study analyzes the trajectory of youth emergency room or inpatient hospital visits for depression or anxiety in Illinois before and during the COVID-19 pandemic.
METHODS: We analyze emergency department (ED) outpatient visits, direct admissions, and ED admissions by patients ages 5-19 years coded for depression or anxiety disorders from 2016 through June 2023 with data from the Illinois Hospital Association COMPdata database. We analyze changes in visit rates by patient sociodemographic and clinical characteristics, hospital volume and type, and census zip code measures of poverty and social vulnerability. Interrupted times series analysis was used to test the significance of differences in level and trends between 51 pre-pandemic months and 39 during-pandemic months.
RESULTS: There were 250,648 visits to 232 Illinois hospitals. After large immediate pandemic decreases there was an estimated -12.0 per-month (p = 0.003, 95% CI -19.8-4.1) decrease in male visits and a - 13.1 (p = 0.07, 95% CI -27 -1) per-month decrease in female visits in the during-pandemic relative to the pre-pandemic period. The reduction was greatest for outpatient ED visits, for males, for age 5-9 and 15-19 years patients, for smaller community hospitals, and for patients from the poorest and most vulnerable zip code areas.
CONCLUSIONS: llinois youth depression and anxiety hospital visit rates declined significantly after the pandemic shutdown and remained stable into 2023 at levels below 2016-2019 rates. Further progress will require both clinical innovations and effective prevention grounded in a better understanding of the cultural roots of youth mental health.

OBJECTIVE: To examine the association between neighborhood-level social vulnerability on the severity of obstructive sleep apnea (OSA) in patients undergoing drug-induced sleep endoscopy (DISE).
METHODS: Single center retrospective cohort study.
METHODS: We conducted a retrospective chart review of patients >18 years of age that underwent DISE from July 2016 to July 2022. Patient addresses were geocoded with geographic information systems, and spatial overlays were used to assign census-tract level social vulnerability index (SVI) scores in the four sub-themes: Socioeconomic (theme 1), Household Composition/Disability (theme 2), Minority Status/Language (theme 3), and Housing/Transportation (theme 4).
RESULTS: The study included 165 patients (61.2 years ± 11.6; 31.0 BMI ± 6.1, 102 male, 63 female). Mild OSA was present in13 patients; 55 patients had moderate OSA; and 97 patients had severe OSA. A higher SVI value in minority status and language, and a higher BMI both predicted an increased Apnea Hypopnea Index (AHI) (p = 0.042, and <0.001, respectively) in the multivariate model; whereas, race, age, gender, or the other three SVI sub-theme values were not predictive.
CONCLUSIONS: Adults residing in areas of greater social vulnerability - specifically a larger minority presence or English as a second language - and patients who are obese are more likely to have more severe OSA. There was no correlation, however, between obesity and residence in an area of high SVI. These results suggest that both neighborhood conditions and obesity are associated with OSA severity. This elevated risk has potential implications for diagnostic testing, clinic follow-ups, screening, and treatment plans for adults residing in disenfranchised neighborhoods.
METHODS: IV.