Lee Yu-Che, Fadell Francois, Chang Ko-Yun, Baek Jessica, Rahman Muhaimen, Kickel Corrine, El-Solh Ali
Division of Pulmonary and Critical Care Medicine, University at Buffalo, Buffalo, NY.
Harvard T.H. Chan School of Public Health, Boston, MA.
Crit Care Med. 2025 Apr 1;53(4):e992-e997. doi: 10.1097/CCM.0000000000006620. Epub 2025 Feb 13.
To examine the association between social vulnerability index (SVI) and social deprivation index (SDI) with critical illness-related mortality in the United States and to guide future research and interventions aimed at reducing disparities in outcomes in patients with critical illness.
A cross-sectional study using county-level data.
United States with data sourced from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research and the American Community Survey.
County-level populations of all ages across the United States from 2015 to 2019.
None.
Age-adjusted mortality rates for four categories of critical illnesses (respiratory, cardiac, neurologic, and renal/gastrointestinal) were analyzed against the county-level SVI and SDI. We assessed critical illness-related mortality associated with SVI and SDI through negative binomial regression models. Mortality rates per 100,000 were highest for cardiac (212.4; 95% CI, 212.2-212.6), followed by respiratory (116.8; 95% CI, 116.7-117.0), neurologic (30.8; 95% CI, 30.8-30.9), and renal/gastrointestinal illnesses (25.2; 95% CI, 25.1-25.3). Mortality was greater among adults 65 years old and older, males, Black or African American individuals, and those living in rural areas. Higher SVI and SDI were associated with increased mortality, with the strongest correlation found for cardiac critical illnesses, showing rate ratios of 1.52 (95% CI, 1.48-1.57) for SDI and 1.43 (95% CI, 1.39-1.47) for SVI. Specific diagnoses with the highest incidence rate ratios included sepsis (1.63 [95% CI, 1.58-1.69] for SVI and 1.75 [95% CI, 1.70-1.80] for SDI), cardiac arrest (1.92 [95% CI, 1.80-2.04] for SVI and 1.98 [95% CI, 1.86-2.10] for SDI), anoxic brain damage (1.62 [95% CI, 1.45-1.81] for SVI and 1.60 [95% CI, 1.45-1.76] for SDI), and acute hepatic failure (1.51 [95% CI, 0.92-2.46] for SVI and 1.49 [95% CI, 1.08-2.05] for SDI). The SDI demonstrated a stronger correlation with mortality compared with the SVI, with socioeconomic status, poverty, education, and unemployment being the most impactful indicators.
Critical illness mortality is significantly associated with indicators of socioeconomic disadvantage. The SDI appears to be a more effective tool than the SVI for guiding resource allocation. Targeted interventions to address social determinants of health, including poverty, education, and unemployment, are essential to reduce disparities and improve outcomes in patients with critical illness. Public health strategies should focus on addressing these social determinants and enhancing support for vulnerable populations and areas.
研究美国社会脆弱性指数（SVI）和社会剥夺指数（SDI）与危重症相关死亡率之间的关联，以指导未来旨在减少危重症患者结局差异的研究和干预措施。
一项使用县级数据的横断面研究。
美国，数据来源于疾病控制与预防中心的广泛流行病学在线数据以及美国社区调查。
2015年至2019年美国各年龄段的县级人口。
无。
针对四类危重症（呼吸、心脏、神经和肾脏/胃肠道）的年龄调整死亡率，根据县级SVI和SDI进行分析。我们通过负二项回归模型评估与SVI和SDI相关的危重症死亡率。每10万人的死亡率中，心脏疾病最高（212.4；95%置信区间，212.2 - 212.6），其次是呼吸系统疾病（116.8；95%置信区间，116.7 - 117.0）、神经系统疾病（30.8；95%置信区间，30.8 - 30.9）以及肾脏/胃肠道疾病（25.2；95%置信区间，25.1 - 25.3）。65岁及以上成年人、男性、黑人或非裔美国人以及农村地区居民的死亡率更高。较高的SVI和SDI与死亡率增加相关，在心脏危重症中相关性最强，SDI的率比为1.52（95%置信区间，1.48 - 1.57），SVI的率比为1.43（95%置信区间，1.39 - 1.47）。发病率率比最高的特定诊断包括败血症（SVI为1.63 [95%置信区间，1.58 - 1.69]，SDI为1.75 [95%置信区间，1.70 - 1.80]）、心脏骤停（SVI为1.92 [95%置信区间，1.80 - 2.04]，SDI为1.98 [95%置信区间，1.86 - 2.10]）、缺氧性脑损伤（SVI为1.62 [95%置信区间，1.45 - 1.81]，SDI为1.60 [95%置信区间，1.45 - 1.76]）以及急性肝衰竭（SVI为1.51 [95%置信区间，0.92 - 2.46]，SDI为1.49 [95%置信区间，1.08 - 2.05]）。与SVI相比，SDI与死亡率的相关性更强，社会经济地位、贫困、教育和失业是最具影响力的指标。
危重症死亡率与社会经济劣势指标显著相关。对于指导资源分配，SDI似乎是比SVI更有效的工具。针对包括贫困、教育和失业在内的健康社会决定因素的有针对性干预措施，对于减少差异和改善危重症患者的结局至关重要。公共卫生策略应侧重于解决这些社会决定因素，并加强对弱势群体和地区的支持。
