P3.K213: Cradle to Grave: The intersection of social vulnerability and pediatric injury fatalities

Background: Unintentional injuries are the leading cause of childhood death in the United States. Social vulnerability, a measure originally used to evaluate communities at higher risk of complications following natural disasters, measured by the social vulnerability index (SVI), has been associated with greater injury risk. However, the overlap in injury-related mortality risk by SVI looking at multiple mechanisms has been less explored. Our study evaluated the association of SVI with the five most common causes of injury-related death among children and young adults (0-24y) in the state of Georgia.

Methods: We conducted a cross-sectional study utilizing Georgia Department of Vital Records death certificates from 2011-2021. We evaluated the association between incident deaths from drownings, firearms, motor vehicle collisions (MVCs), poisonings, and sleep-related death (SUID) with census-level SVI defined by the CDC (i.e., a composite SVI divided into quartiles). We evaluated incident deaths for each cause stratified by the four subcategories of SVI (socioeconomic, household composition/disability, minority/language, housing type/transportation). To determine factors associated with incident injury-related causes of death among children, we modeled outcomes using negative binomial regression controlling for cause of death and SVI.

Results: 10,643 deaths were included (531 from drownings, 3798 from firearms, 3414 from MVCs, 1163 from poisonings, and 1737 SUID). Most of the deaths were in males (7845, 74%) (Table 1). SVI themes 1 (socioeconomic) and 3 (minority/language) had the strongest correlation with incident deaths (Table, Figure) In these themes, firearm deaths had the greatest disparities between the lowest and highest SVI quartiles. Conversely, poisoning showed an inverse relationship in all four SVI sub-themes between SVI quartiles, with a higher number of deaths for the most advantaged SVI in all subcategories. SVI appeared to have the least impact on drowning deaths but also had the fewest cases.

Conclusion: Our study supports that SVI continues to correlate with injury deaths, with more socially vulnerable children having higher rates of injury deaths. It adds valuable information that poisoning deaths go against typical injury trends and that disparities in incident deaths are greatest in those affected by firearm injury, indicating a pressing need to address this vulnerable population. By determining which SVIs are associated with each mechanism, we can provide targeted resources to prevent these untimely deaths.