Social Vulnerability Is Associated With Traumatic Reinjury and Increased Long-Term Mortality

The Social Vulnerability Index (SVI) was created by the Centers for Disease Control and Prevention to identify populations at risk after natural disasters but is increasingly used for understanding healthcare outcomes. The purpose of this study was to determine the relationship between social vulnerability, reinjury, and long-term mortality.

We retrospectively identified adult trauma admissions during 2015-2021 at a Level I trauma center with mortality follow-up through 2024. Reinjury was determined as patients who were admitted to the hospital with a new traumatic event. Patients were categorized into low (<75%) versus high (≥75%) SVI. Bivariate analysis was performed using chi-squared and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. An adjusted Cox proportional hazards model for mortality was performed, and a multiple logistic regression model was performed to determine risk-adjusted reinjury.

Of the 7181 patients analyzed, 36% were classified as high SVI. Individuals with high SVI had higher rates of penetrating injury (12.20% versus 7.10%, P < 0.001) and were more likely to sustain a traumatic reinjury (3.71% versus 2.30%, P < 0.001). High SVI was associated with increased risk-adjusted likelihood of traumatic reinjury (1.89 [1.41-2.53], P < 0.05). Adjusted Cox proportional hazards analysis showed high SVI had a hazard ratio for long-term mortality of 1.130 (1.002-1.273, P < 0.05). Hazard ratios were increased for preexisting conditions (3.92 [3.03-5.07], P < 0.05) and decreased for race and ethnicity other/unknown (0.790 [0.625-0.999], P < 0.05).

Social vulnerability is associated with greater risk of reinjury and subsequent long-term mortality in trauma patients.