CDC’s Social Vulnerability Index predicts CDI severity, mortality
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Key takeaways:
- A high social vulnerability index score may indicate a risk for greater severity of C. difficile infection.
- Living conditions, neighborhood and race may play a role in access to health care.
The four core concepts of the CDC’s Social Vulnerability Index could be used to predict the severity of Clostrioides difficile infection and all-cause mortality, according to a study presented at IDWeek.
“We know that people of marginalized race and ethnicity are more likely to reside in areas of high social vulnerability, which then prohibits them receiving certain access and health care provisions,” Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, assistant professor of clinical pharmacy at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, said during a press briefing ahead of IDWeek.
The CDC and Agency for Toxic Substances and Disease Registry’s Social Vulnerability Index uses 16 U.S. census variables to determine areas that could need significant support before, during or after a disaster.
The index groups these variables into four themes to create a measure of social vulnerability. The four themes — socioeconomic status; household characteristics; racial and ethnic minority status; and housing type and transportation — allow government agencies and planners to identify communities most in need of support.
Abdul-Matakabbir said that she and her colleagues found in a previous study that racially and ethnically minoritized groups have a higher risk for C. difficile infection (CDI), as well as an increased risk in the severity of infection and an increase in chronic comorbidities.
This made them curious whether social vulnerability or deprivation plays a role in CDI rates and severity because some communities have better or worse access to health care, and it is possible this increases risk for infection and severe disease, she said.
Abdul-Mukakabbir and colleagues analyzed data on 206 adults admitted to the Loma Linda Medical Center in California with an initial CDI episode between January 2020 and June 2021.
The researchers collected patient addresses, feeding them into the interactive index map and splitting participants into two subgroups: patients with index scores lower than 0.4999 were categorized as low vulnerability (LV) and those with index scores higher than 0.5 were categorized as high vulnerability (HV).
Overall, patients in the HV index score group (31.55% of patients) were more likely to arrive at the ED with a more severe infection and more likely to have higher all-cause mortality than those with an LV score (7.28%), according to the study.
The frequency for initial severe CDI was threefold greater for the index themes of socioeconomic status and household characteristics, which each included 61 HV patients (29.61%) present with severe CDI compared with 19 LV patients (9.22%). For the housing type and transportation theme, patients with an HV score were more likely to have severe CDI (29.21% vs. 5.34%) or fulminant CDI (13.11% vs. 0.49%) than those with an LV score.
Finally, for the racial and ethnic minority status theme, the researchers reported that patients with fulminant CDI were 37 times more likely to have an HV score than an LV score (17.96% vs. 0.49%) and nine times greater mortality (8.74% vs. 0.97%).
“What this tells us is that, health equity-wise, persons from highly vulnerable areas may necessitate more resources or higher level of care to address these external factors,” Timothy Afable, Pharm D, RPh, pharmacy resident at Loma Linda University Health, said during the briefing.
References:
- Afable T, et al. Abstract 205. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
- CDC. Agency for toxic substances and disease registry: CDC/ATSDR Social Vulnerability Index (SVI): Overall SVI nationwide comparison: By county: 2022. https://www.atsdr.cdc.gov/placeandhealth/svi/interactive_map.html. Published Dec. 1, 2022. Accessed Oct. 23, 2024.
- CDC. Agency for toxic substances and disease registry: CDC/ATSDR Social Vulnerability Index (CDC/ATSDR SVI): Overview. https://www.atsdr.cdc.gov/placeandhealth/svi/index.html. Published June 14, 2024. Accessed Oct. 23, 2024.
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Afable T, et al. Abstract 205. Presented at: IDWeek; Oct. 16-19, 2024; Los Angeles.
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