Category: Diabetes
Poster Session II
Gestational and pregestational diabetes (DM) disproportionately affect racial/ethnic minorities and those with low socioeconomic status (SES). Given multiple social determinants of health involved, we evaluated the association between social vulnerability index (SVI), a composite of 4 themes measuring community vulnerability to health stressors, and adverse outcomes.
Study Design:
Retrospective cohort study of Alabama residents with gestational or pregestational DM who delivered a singleton at ³22 weeks at a tertiary care center (1/2012-1/2022). Those with only a PO box address were excluded. Composite SVI scores were derived from addresses and categorized into tertiles. The primary outcome was preterm birth (PTB) < 34wk. Secondary outcomes were preeclampsia, NICU admission >24hr, SGA, LGA, and perinatal death. We compared outcomes by SVI tertiles and used multivariable regression to estimate the association between composite SVI and SVI theme scores (as continuous exposures) and outcomes.
Results:
Of 4,282 patients included, 2,926 (68%) had gestational, 961 (22%) type 2 and 385 (9%) type 1 DM. Baseline characteristics differed by SVI tertile including DM type, race/ethnicity, BMI, and medical comorbidities. Compared to low SVI, those with moderate and high SVI were more likely to have PTB < 34wk, preeclampsia, SGA, and perinatal death (Fig 1). While composite SVI was associated with higher odds of key outcomes, the associations between SVI theme scores and outcomes were not consistent (Fig 2). For example, higher SVI scores in theme 1 (SES) and often 2 (household/disability) and 4 (housing/transportation) were associated with higher odds of adverse outcomes, but higher SVI scores in theme 3 (minority/language) were associated with lower odds of PTB < 34wk, NICU >24hr, and LGA.
Conclusion:
Living in areas of higher social vulnerability overall was associated with higher odds of morbidity in patients with gestational or pregestational DM. However, further investigation is needed to understand why higher vulnerability related to minority/language was protective against adverse outcomes.
Vasiliki B. Orfanakos, BSc, MD
Resident Physician
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Macie L. Champion, MD
Instructor/Fellow
University of Alabama at Birmingham
Birmingham, Alabama, United States
Ariann Nassel, MA
University of Alabama at Birmingham
Birmingham, Alabama, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Ashley N. Battarbee, MD,MSCR
Assistant Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States