P1.055: Evaluating the Impact of Individual SVI Metrics on Overall SVI Scores for Patients in a Spanish Language-Concordant Pediatric Surgery Clinic

Background: Social Vulnerability Index (SVI) is a composite score based on neighborhood-level social determinants of health with higher scores identifying more socially disadvantaged patients. This study aimed to compare the individual SVI metrics for patients seen in our Spanish language-concordant pediatric surgery clinic (“Clínica de Cirugía Pediátrica” [CCP]) and contemporary pediatric surgery clinics (CSC) to assess the primary drivers of overall SVI scores.

Methods: A retrospective cohort study was performed for all patients seen in pediatric surgery clinics from October 2021 to September 2024 at a single, quaternary referral freestanding children’s hospital. Data collection included patients’ primary language, overall SVI and SVI in individual metrics, including housing type and transportation, household characteristics, socioeconomic status, and racial ethnic and minority status. SVI metrics were compared between patients seen in CCP vs. CSC and by preferred language (English vs. Spanish) using two-way ANOVA. Logistic regression models to predict the clinic where patients received care were fit for the different metrics of SVI. Multivariate models adjusting for SVI and language were also performed. Geocoded addresses were used to map each patient’s residence to visualize SVI metric in housing type and transportation.

Results: There were 6,317 patients included, with 170 seen in CCP and 6,147 seen in CSC. Among CCP patients, 91 (53.5%) were English-speaking and 78 (45.9%) were Spanish-speaking. Among CSC patients, 5,555 (90.4%) were English-speaking and 499 (8.1%) were Spanish-speaking. Average overall SVI for CCP patients was 58.6% compared to 44.4% for CSC patients (p < 0.001). For every 10% increase in SVI metric in racial ethnic and minority status, and in household characteristics, patients had 29% [95% CI 1.17-1.42] and 17% [95% CI 1.11 -1.25] increased odds of receiving care in CCP vs CSC (both p< 0.001) (Figure 1). While adjusting for SVI metric in housing type and transportation, Spanish-speaking patients had 9.3 [95% CI 6.59 -13.17] times increased odds of receiving care in CCP vs CSC (p < 0.001) (Figure 1). A map of the patients’ residencies with SVI in the housing type and transportation metric shows that CCP patients are concentrated in specific areas in Colorado whereas CSC patients are more widespread (Figure 2).

Conclusion: Patients receiving care in CCP have a higher overall SVI compared to patients in CSC; however, there was no specific SVI metric driving this higher score. Patients were more likely to attend CCP with a high SVI metric in the housing type and transportation and geocoded maps demonstrated high presence of these patients at specific locations in Colorado. Future studies are needed assessing the impacts of interventions in housing status and transportation on individual vulnerability.