732 - Impact of Social Vulnerability on Mortality in Children and Young Adults in the Western United States

Publication Number: 732.5416

Grace A. Cudjoe, Mercy Health St. Vincent Medical Center, Toledo, OH, United States; Belinda Kwartemaa Nti, Mayo Clinic Children's Center, Rochester, MN, United States; Ama Dokyi, University of Ghana Medical Centre, Accra, Greater Accra, Ghana; Chinenye N. Amanze, Kwame Nkrumah University of Science and Technology, Calgary, AB, Canada; Valerie Shamwun. Mainsah, University of Washington/ Seattle Children's Hospital, Seattle, WA, United States; Fredrick Dapaah-Siakwan, Valley Children's Healthcare, Fresno, CA, United States

Background: Social vulnerability refers to the resilience of communities when exposed to external stresses on human health. Vulnerable populations often experience challenges such as limited access to healthcare and environmental hazards, which collectively influence morbidity and mortality. Prior research has highlighted the role of social vulnerability on health outcomes but its impact on mortality in children and young adults remains underexplored.

Objective: We investigated the impact of county-level social vulnerability index (SVI) on mortality rates among children and young adults in the Western United States (US).

Design/Methods: This was a retrospective cross-sectional study that matched the 2022 county-level SVI data from the Agency for Toxic Substances and Disease Registry and crude mortality rates of children 0-24 years (CMR) in the Western US from 2018-2022 from the CDC’s Wide-ranging Online Data for Epidemiologic Research database. We calculated scores for overall SVI and its 4 subcomponents (i.e. socioeconomic status; household characteristics; racial and ethnic minority status; and housing type and transportation) using 16 social attributes (Figure 1). SVI scores were presented as percentile rankings by county, further classified as quartiles based on their distribution among all US counties (1st [least vulnerable] = 0 - 0.25; 4th [most vulnerable = 0.75 - 1.00]). Counties with death counts < 10 or population < 100,000 were excluded per CDC guidelines. CMR per 100,000 with 95% confidence intervals (CI) were stratified by overall SVI and its subcomponents, and by age, sex, race, and urbanization. A negative impact of SVI was characterized by CMR of SVI-Q4 greater than SVI-Q1 with non-overlapping CIs.

Results: From 2018 to 2022, the overall CMR for children and young adults was 69.5 per 100,000. Counties in SVI-Q4 had a significantly higher CMR (83.3; CI: 76.7-90.9) and an excess of 28.9 deaths per 100,000 when compared to SVI-Q1 (54.5; CI:41.8-67.0 (Table 1). Similarly, for overall SVI, counties in SVI-Q4 had higher CMR and excess CMR when compared to SVI-Q1 in males, both urban and rural counties, ages 0-5 years, and ages 20-24 years. Of the four subcomponents of the SVI, SVI-Q4 had higher CMR (86.9; CI:78.8-95) than SVI-Q1 (51.5; CI:39.6-63.4) in only the socioeconomic status domain.

Conclusion(s): Higher county-level SVI was associated with increased CMR in children and young adults in the Western US. Public health strategies and policies that allocate more resources to vulnerable communities can help mitigate the negative impact of social vulnerability on mortality in children.

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Figure 1. Social Vulnerability Index (SVI) and underlying themes
Social Vulnerability Index (SVI) and underlying themes