Ramgopal Sriram, Crowe Remle P, Misra Anjali J, Cash Rebecca E
Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Public Health Rep. 2025 Aug 21:333549251357818. doi: 10.1177/00333549251357818.
Multiple measures are used to assess neighborhood disadvantage. Although each was created with a unique purpose, they share conceptual and methodological overlap. We examined the correlation among 3 measures of neighborhood disadvantage (Social Vulnerability Index [SVI], Area Disadvantage Index [ADI], and Social Deprivation Index [SDI]) and their association with quality indicators for adults with prehospital emergencies.
We performed a retrospective analysis using a national multiagency emergency medical services (EMS) database, including emergency scene encounters for adults (aged ≥18 y) with available census-tract SDI and SVI data and census-block ADI data from January 1 through December 31, 2023. We compared the SVI, ADI, and SDI using overall and pairwise intraclass correlation coefficients (ICCs). We evaluated the association of each index with 7 quality indicators for prehospital care developed by the National EMS Quality Alliance.
We included 9 259 983 encounters (median [IQR] age, 63 [44-77] y). The overall ICC between indices was 0.65, indicating moderate agreement. We found higher agreement between SVI and SDI (ICC = 0.84) than between SVI and ADI (ICC = 0.54) or ADI and SDI (ICC = 0.59). We found overlap among the indices for most outcomes, although we found differences in ADI associations compared with SVI and SDI for some outcomes. These included bronchodilator use in asthma (SDI/SVI positively associated, ADI not associated), treatment of hypoglycemia (ADI negatively associated, SDI/SVI not associated), and screening of suspected stroke (SDI/SVI negatively associated, ADI not associated).
We found moderate agreement among 3 commonly used indices of neighborhood disadvantage. Research is needed to refine the application of these indices to prehospital care and explore their utility in reducing health disparities across health care settings.
采用多种指标评估社区劣势。尽管每个指标的创建目的独特，但它们在概念和方法上存在重叠。我们研究了3种社区劣势指标（社会脆弱性指数[SVI]、区域劣势指数[ADI]和社会剥夺指数[SDI]）之间的相关性，以及它们与院前急诊成年患者质量指标的关联。
我们使用国家多机构紧急医疗服务（EMS）数据库进行回顾性分析，包括2023年1月1日至12月31日期间成年（年龄≥18岁）患者的急诊现场遭遇情况，这些患者具备普查区SDI和SVI数据以及普查街区ADI数据。我们使用总体和两两组内相关系数（ICC）比较SVI、ADI和SDI。我们评估了每个指数与国家EMS质量联盟制定的7项院前护理质量指标的关联。
我们纳入了9259983次遭遇（年龄中位数[四分位间距]，63[44 - 77]岁）。各指数之间的总体ICC为0.65，表明一致性中等。我们发现SVI和SDI之间的一致性（ICC = 0.84）高于SVI和ADI之间（ICC = 0.54）或ADI和SDI之间（ICC = 0.59）。我们发现大多数结果的指数之间存在重叠，尽管在某些结果中，与SVI和SDI相比，ADI的关联存在差异。这些差异包括哮喘患者使用支气管扩张剂（SDI/SVI呈正相关，ADI无关联）、低血糖治疗（ADI呈负相关，SDI/SVI无关联）以及疑似中风筛查（SDI/SVI呈负相关，ADI无关联）。
我们发现3种常用的社区劣势指数之间存在中等程度的一致性。需要开展研究以完善这些指数在院前护理中的应用，并探索它们在减少不同医疗环境中健康差距方面的效用。
