Comparison of community-level deprivation indices and their association with adverse pregnancy outcomes.

BACKGROUND: The Social Vulnerability Index, Maternal Vulnerability Index, and Area Deprivation Index measure community-level resilience to stressors, vulnerability to adverse maternal health outcomes, and socioeconomic disadvantages, respectively. These indices are commonly used to gauge community-level influence on health outcomes. Thus, for them to serve as effective clinical tools, their ability to predict adverse obstetrical outcomes must be evaluated.

OBJECTIVE: This study aimed to compare the 3 indices and their associations with adverse pregnancy outcomes.

STUDY DESIGN: This was a secondary analysis of a prospective cohort study of singleton pregnancies from 2017 to 2020. The parent study excluded non-English-speaking patients and those with in vitro fertilization pregnancies. The primary and secondary outcomes were composite adverse obstetrical and neonatal outcomes, respectively. These outcomes were compared between patients with low Social Vulnerability Index, Maternal Vulnerability Index, and Area Deprivation Index (less vulnerable/disadvantaged) and those with high Social Vulnerability Index, Maternal Vulnerability Index, and Area Deprivation Index (more vulnerable/disadvantaged). Multivariate logistic regression was performed to account for potential confounders, and a stratified analysis was performed to evaluate for effect modification by race. Receiver operating characteristic curves were generated to assess each index's ability to predict an adverse outcome.

RESULTS: Among 1260 birthing people in the cohort, 1055 (83.7%), 1065 (84.5%), and 1029 (81.7%) had data to calculate the Social Vulnerability Index, Maternal Vulnerability Index, and Area Deprivation Index, respectively. In the cohort, the median Social Vulnerability Index was 0.65 (interquartile range, 0.32-0.84), the median Maternal Vulnerability Index was 75.00 (interquartile range, 33.60-75.00), and the median Area Deprivation Index was 7.00 (interquartile range, 3.00-9.00). In the overall cohort, a high Social Vulnerability Index was associated with adverse obstetrical outcomes (adjusted odds ratio, 1.80 [95% confidence interval, 1.38-2.34]). In contrast, high Maternal Vulnerability Index and Area Deprivation Index did not reach statistical significance. None of the indices were significantly associated with composite adverse neonatal outcomes. The area under the curve for the Social Vulnerability Index to predict an adverse obstetrical outcome was 0.59. The areas under the curve for the Maternal Vulnerability Index and Area Deprivation Index were 0.58. Of note, 56% of the entire cohort self-identified as Black. In the stratified analysis by race, the association between either of the 3 high indices and an adverse obstetrical outcome was not modified by race (P value for interaction of >.05).

CONCLUSION: Patients living in areas with a high Social Vulnerability Index were more likely to have an adverse obstetrical outcome than those living in areas with a lower Social Vulnerability Index. Among the 3 indices, the Social Vulnerability Index might be the most reliable index to capture community-level stressors that influence obstetrical outcomes and is not modified by race. However, all 3 indices have modest predictive capabilities, highlighting the need to identify better measures of community-level determinants of pregnancy outcomes. El resumen está disponible en Español al final del artículo. VIDEO.