O2154: The Relationship Between CDC Social Vulnerability Index and Treatment Course Characteristics in Infants with Surgically Intervenable Congenital Anomalies

Background: Disparities in healthcare outcomes have been associated with structural determinants of health such as socioeconomic status (SES) and racism. The Center for Disease Control developed the Social Vulnerability Index (SVI) which quantifies the risk for adverse outcomes from external stressors with increasing vulnerability at higher SVI scores. Limited data exists on the relationship between SVI and treatment outcomes for patients with congenital anomalies. Our objective was to evaluate the impact of SVI on perinatal and infant outcomes in patients with surgically treatable congenital anomalies.

Methods: A retrospective study of birth-parent-infant dyads diagnosed from 2014-2022 with surgically intervenable congenital anomalies of congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), intestinal atresia (IA), sacrococcygeal teratoma (SCT), omphalocele, gastroschisis, myelomeningocele (MMC), or lower urinary tract obstruction (LUTO). SVI combines 16 variables to describe SES, household characteristics, racial and ethnic minoritized status and housing type/transportation access. Collected data included demographics, birth-parent co-morbidities, provision of care (e.g. use of advanced imaging, gestational age at diagnosis, prenatal consultation with pediatric specialist) and postnatal outcomes (e.g. surgical complications or death). Dyads were grouped into SVI quartiles based on residential address. Descriptive statistics and unadjusted odds ratios for death or morbidity were performed stratified by SVI.

Results: 295 dyads were studied: 33 (11.2%) CDH, 20 (6.8%) TEF, 43 (14.6%) IA, 1 (0.3%) SCT, 24 (8.1%) omphalocele, 75 (25.4%) gastroschisis, 58 (19.7%) MMC, 27 (9.2%) LUTO, 13 (4.4%) two diagnoses, 1 (0.3%) three diagnoses. Of these, 10.2% had Low SVI, 23.7% Low-Medium, 35.3% Medium-High, and 30.9% High. The sample was majority white (84.7%). Increasing SVI quartile was positively correlated with self-identification of Hispanic ethnicity and rates of public health insurance (p < 0.001) [Table 1], but was not directionally related to marital status, language preference, infant or maternal race.

Of birth parent comorbidities chronic hypertension, diabetes, mental health condition, substance or alcohol use disorder were not related to SVI quartile. SVI quartile was associated with levels of smoking tobacco (p = 0.011) and was not significantly associated with provision of care outcomes, except for utilization of fetal magnetic resonance imaging (p = 0.04) [Table 1].

SVI quartile was not significantly associated with adverse clinical outcomes (diagnosis of sepsis, birth complications, surgical complications, unplanned readmission within 90 days, respiratory failure, and death before discharge) [Table 2].

Conclusion: Although the degree of social vulnerability was not associated with adverse infant outcomes, there was a trend towards worse outcome with greater degree of social vulnerability. This is the first study to investigate postnatal surgical outcomes in children with congenital anomalies by SVI, which is a crucial step in evaluating and planning for social support and public health initiatives. Further research includes planned collaboration with additional health systems to increase sample size and diversity.