Area-based Deprivation Indices and Healthcare-Associated Infections: A Narrative Review of Evidence

Since the coronavirus disease-19 (COVID-19) pandemic started, there has been a rise in published studies using area-based deprivation indices to explore the link between neighborhood-level social determinants of health (SDoH) and susceptibility to infectious diseases. However, questions remain about how these deprivation indices were developed and how effective they are at identifying and addressing healthcare-associated infection (HAI) disparities. This review aims to clarify the origins of the most commonly used deprivation indices in HAI epidemiology research and to offer key considerations and recommendations for their use to enhance prevention strategies and advocacy efforts.

The two most frequently used area-based deprivation indices in HAI epidemiology research are the area deprivation index and the social vulnerability index. Of interest, both indices use data from the American Community Survey disseminated by the US Census Bureau to describe area-level socioeconomic and material deprivation across various geographic areas nationwide. Researchers have combined these area-based indices with clinical and individual-level sociodemographic variables and found that higher levels of disadvantage correlate with an increased occurrence of HAIs. Despite similarities in findings when using these indices, they have distinct differences that should be considered.

Area-level deprivation can increase an individual's risk of HAIs, and deprivation indices are tools that can quantify this relationship. Despite the availability of relevant data, there is a need to expand the existing literature using deprivation indices in HAI research. Ultimately, this exploratory research has the potential to inform prevention strategies and policy reforms aimed at reducing disparities in HAIs.