(113) Association of social vulnerability index on COVID-19 infection severity during pregnancy

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: Pregnant people are more susceptible to severe COVID-19 illness and social disparities may further contribute to poor outcomes. The social vulnerability index (SVI) assesses the degree to which a community exhibits certain social vulnerabilities (higher SVI denoting higher vulnerability). We sought to evaluate the association between SVI and COVID-19 severity in a pregnant population.

Study Design: Retrospective cohort of all pregnant Alabama residents diagnosed with COVID-19 (3/2020-4/2022) at a single institution. Patient addresses were used to assign scores (0-1), categorized as low (0-0.33), medium (0.34-0.66), and high SVI (0.67-1). Primary outcome was disease severity. Outcomes were compared across groups, and adjusted odds ratios (95% CI) estimated the association between medium and high SVI with outcomes, compared to low SVI. Secondary analysis evaluated outcomes across individual SVI themes.

Results: Of 597 patients, 151 (25%) had low, 184 (31%) medium and 262 (44%) high SVI. Patients with higher SVI were younger, more likely to be African American and less likely to have private insurance or asthma (p < 0.05). While disease severity was significantly different across SVI groups (p=0.019), after adjustment, there was no difference in odds of disease severity (Table 1). Patients with higher SVI scores were significantly less likely to be vaccinated. Other disease-specific and perinatal outcomes were similar across groups (Table 1). Patients with mild/moderate disease had less vulnerability (lower mean SVIs) in themes 1 (socioeconomic) and 2 (housing) compared to asymptomatic persons; these differences were not significant for severe/critical disease. Greater vulnerability (higher SVIs scores) in all themes, except minority status, was associated with decreased vaccination (Table 2).

Conclusion: Increasing community-level social vulnerability was not associated with more severe disease or adverse outcomes in our pregnant population. It was, however, associated with decreased vaccination. Interventions that target improving community-level SVI may be important when trying to increase vaccination.

Primary & Presenting Author(s)

Angela R. Seasely, MD, MS (she/her/hers)
Fellow
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States

Coauthor(s)

CB
Christina T. Blanchard, MS
Statistician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
AN
Ariann Nassel, MA
University of Alabama at Birmingham
Birmingham, Alabama, United States
JD
Jodie Dionne Odom, MD
Assistant Professor
Department of Infectious Diseases, University of Alabama Birmingham
Birmingham, Alabama, United States
Rachel Sinkey, MD (she/her/hers)
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
BC
Brian M. Casey, MD
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Alan T. Tita, MD, PhD
Professor
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