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Comparing Deprivation vs Vulnerability Index Performance Using Medicare Beneficiary Surgical Outcomes
Kimberly A Rollings1,2, Grace A Noppert2, Jennifer J Griggs3,4
1Health & Design Research Fellowship Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
JAMA Surgery
|October 2, 2024
Summary
The Social Vulnerability Index (SVI) better identifies socioeconomic disparities in surgical outcomes among Medicare beneficiaries compared to the Area Deprivation Index (ADI). Careful index selection is crucial for health equity initiatives.
Area of Science:
- Health Services Research
- Health Equity
- Socioeconomic Determinants of Health
Background:
- Publicly available composite indices of area-level socioeconomic deprivation are increasingly used by healthcare stakeholders to address health equity.
- The implications of selecting specific deprivation indices for policy and resource allocation are not well understood.
Purpose of the Study:
- To compare the performance of two frequently used deprivation indices: the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI).
- To evaluate index performance using policy-relevant outcomes among Medicare beneficiaries undergoing common surgical procedures.
Main Methods:
- A cross-sectional study analyzed outcomes for Medicare beneficiaries (65-99 years) undergoing hip replacement, knee replacement, or coronary artery bypass grafting (2016-2019).
- Tract-level deprivation was measured using ADI and SVI (2020 releases).
- Discriminative performance was compared for beneficiaries in high- vs. low-deprivation tracts using outcomes like unplanned surgery, 30-day readmissions, and 30-day mortality, with multivariable logistic regression.
Main Results:
- Beneficiaries in high-deprivation tracts had significantly greater odds of adverse outcomes across all procedures for both indices.
- The Social Vulnerability Index (SVI) demonstrated superior discriminative performance compared to the Area Deprivation Index (ADI).
- SVI yielded higher adjusted odds ratios, larger outcome rate differences, and greater effect sizes in distinguishing between high- and low-deprivation tracts.
Conclusions:
- The Social Vulnerability Index (SVI) significantly outperformed the Area Deprivation Index (ADI) in stratifying surgical outcomes across a wider range of deprivation levels.
- Index selection requires careful consideration of performance differences and contextual factors, particularly for resource allocation and payment adjustment models.
- Accurate identification of socioeconomic disparities through appropriate index selection is vital for advancing health equity in surgical care.
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