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Abstract
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BACKGROUND: Social vulnerability indices were created to measure resiliency to environmental disasters based on socioeconomic and population characteristics of discrete geographic regions. They are comprised of multiple validated constructs that can also potentially identify geographically vulnerable populations after injury. Our objective was to determine if these indices correlate with injury fatality rates in the US.
METHODS: We evaluated three social vulnerability indices: The Hazards & Vulnerability Research Institute's Social Vulnerability Index (SoVI), the CDC Social Vulnerability Index (SVI) and the Economic Innovation Group's Distressed Community Index (DCI). We analyzed SVI sub-indices and common individual census variables as indicators of socioeconomic status. Outcomes included age-adjusted county-level overall, firearm, and motor vehicle collision (MVC) deaths per 100,000 population. Linear regression determined the association of injury fatality rates with the SoVI, SVI, and DCI. Bivariate choropleth mapping identified geographic variation and spatial autocorrelation of overall fatality, SoVI, and DCI.
RESULTS: 3,137 US counties were included. Only 24.6% of counties fell into the same vulnerability quartile for all three indices. Despite this, all indices were associated with increasing fatality rates for overall, firearm, and MVC fatality. The DCI performed best by model fit, explanation of variance, and diagnostic performance on overall injury fatality. There is significant geographic variation in SoVI, DCI, and injury fatality rates at the county-level across the US, with moderate spatial autocorrelation of SoVI (Moran's I 0.35, p<0.01) and high autocorrelation of injury fatality rates (Moran's I 0.77, p<0.01) and DCI (Moran's I 0.53, p<0.01).
CONCLUSIONS: While the indices contribute unique information, higher social vulnerability is associated with higher injury fatality across all indices. These indices may be useful in the epidemiologic and geographic assessment of injury-related fatality rates. Further study is warranted to determine if these indices outperform traditional measures of socioeconomic status and related constructs used in trauma research. LEVEL OF EVIDENCE: Epidemiological, IV.
Language: en |