High Social Vulnerability Predicts Worse Long-Term Outcomes After Traumatic Injury

Summary: People living in areas with higher social vulnerabilities are more likely to face worse mental and physical outcomes following a traumatic injury.

Source: Brigham and Women’s Hospital

Traumatic injuries — such as physical injuries resulting from a car accident, fall, gunshot or stabbing — are one of the most common causes of impairment and disability worldwide.

A team of investigators led by Juan P. Herrera-Escobar, MD, MPH, of the Brigham’s Center for Surgery and Public Health, found that living in an area with higher social vulnerability is strongly associated with worse mental and physical health outcomes after a traumatic injury.

Areas with high social vulnerability are those with higher poverty and unemployment rates, lower income, higher proportion of racial/ethnic minority groups and people with limited English-speaking ability, more households without vehicles, and crowded housing, among other factors.

The team leveraged data from the Centers for Disease Control and Prevention’s (CDC’s) Social Vulnerability Index (SVI), a data-driven tool used to inform decision about COVID-19 vaccine allocation.

“These findings suggest that community-level social factors play a significant role in recovery after injury,” said Herrera-Escobar.

“The CDC’s SVI could serve in trauma as a branch point in determining referral to a standard set of post-discharge support services and interventions, such as mental health services, assistance with return to work, and rehabilitation services such as physical therapy, occupational therapy.”

Abstract

The Social Vulnerability Index and Long-term Outcomes after Traumatic Injury

Objective:

To evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury.

Background:

The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors.

Methods:

Moderate-severely injured adult patients treated at one of three level-1 trauma centers were prospectively followed six to 14 months post-injury. These data were matched at the census tract level with overall SVI percentile rankings. Patients were stratified based on SVI quartiles, with the lowest quartile designated as low SVI, the middle two quartiles as average SVI, and the highest quartile as high SVI. Multivariable adjusted regression models were used to assess whether SVI was associated with long-term outcomes after injury.

Results:

A total of 3,153 patients were included . The median overall SVI percentile rank was 35th (IQR: 16th-65th). Compared to low SVI patients, high SVI patients were more likely to have new functional limitations (OR, 1.51; 95% CI, 1.19–1.92), to not have returned to work (OR, 2.01; 95% CI, 1.40–2.89), and to screen positive for PTSD (OR, 1.56; 95% CI, 1.12–2.17). Similar results were obtained when comparing average with low SVI patients, with average SVI patients having significantly worse outcomes.

Conclusions:

The SVI has potential utility in predicting individuals at higher risk for adverse long-term outcomes after injury. This measure may be a useful needs assessment tool for clinicians and researchers in identifying communities that may benefit most from targeted prevention and intervention efforts.