The Association of the Social Vulnerability Index with Acuity of Presentation to Obstetric Triage

Adverse social determinants of health are known to be associated with adverse pregnancy outcomes. The objective of this analysis was to assess the association between adverse community-level social determinants of health, measured with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (CDC/ATSDR SVI), and acute presentation to obstetric triage. We hypothesized that adverse community-level social determinants of health would be associated with greater clinical acuity at time of presentation.

This was a secondary analysis of an observational, multi-site cohort study of all triage visits from 20^0/7 to 34^6/7 weeks' gestation occurring from January 1, 2019, to March 31, 2019. Individuals enrolled with geocode and CDC SVI data available were included. The primary exposure was the overall CDC SVI. The primary outcome was presentation to obstetric triage with greater acuity. Secondary outcomes included adverse maternal and neonatal outcomes. Outcomes were compared between groups based on overall SVI and by the four SVI themes. Baseline characteristics were compared. Logistic and quantile regressions were used with the lowest SVI quartile (Q1) group as referent, adjusting for hospital, parity, maternal age, tobacco use, body mass index (BMI) at delivery, drug use, and existing comorbidity.

A total of 2,659 individuals were eligible for analysis. Individuals with higher overall SVI scores were younger and had higher BMI, and were more likely to be multiparous, use tobacco or illicit drugs, and live with co-morbidities. Higher SVI quartiles were not associated with acuity of presentation to triage (Q1 reference; Q2 adjusted odds ratio [aOR]: 0.97, 95% confidence interval [CI]: 0.68-1.38; Q3 aOR: 1.10, 95% CI: 0.76-1.57; Q4 aOR: 1.04, 95% CI: 0.72-1.50).

We found no consistent association between the CDC SVI and acuity of presentation to obstetrical triage. Further research is needed to understand the relationships between adverse community-level social determinants of health and adverse perinatal outcomes.

· There was no association between the CDC SVI and acuity of presentation to obstetric triage, whether SVI was assessed as an overall score or by subtheme.. · This analysis adds to the understanding of the association between adverse community-level social determinants of health and conditions related to preterm delivery.. · This study indicates a need for ongoing research to better understand the mechanisms through which social vulnerability affects pregnancy outcomes..