The Complexity of Social Vulnerability of Person and Place on Mortality After Penetrating Trauma

Social determinants of health impact outcomes after traumatic injury. Patient factors, including race, insurance status, and household income, have been associated with increased risk of mortality and worse outcomes. The social vulnerability index (SVI) is a comprehensive tool that quantifies these factors at the census tract or county level. We hypothesized that mortality after admission for penetrating trauma would be associated with higher vulnerability.

We queried our level 1 trauma center supplemental database from 2019 to 2021 for mortality among adult patients presenting with a penetrating traumatic injury (n = 103). We assigned SVI based on patient address and location of injury. We used chi-square tests for association for all categorical variables and Mann-Whitney U tests for continuous variables. We then conducted a logistic regression and mediation analysis to assess the effect of injury severity score on mortality.

We found a significant association between SVI and mortality after comparing low and high SVI. While most patients with penetrating trauma came from the areas of highest SVI (64%), patients with low SVI (2^nd and 3^rd quartiles) had a higher mortality than those of the highest quartile (33.3% versus 14.1%, P = 0.021). High vulnerability was associated with improved survival and lower rates of all-cause mortality; however, this association was entirely mediated by the greater range of injury severity seen in the high-vulnerability group. The correlation between individual SVI and SVI of place of injury was strong.

SVI is associated with patient mortality after penetrating trauma in our locale, but not in the ways that we assumed. Our data suggest that we are missing the areas where disparity in care exists when considering only patients who make it to a trauma center. This may reflect the vulnerability of the immediate area around our institution such that a greater range of survivable injury presents and emphasizes the utility of secondary and tertiary violence prevention in the communities immediately surrounding our hospital.