The association between social vulnerability index and preeclampsia

Social vulnerability index (SVI) measures a community’s vulnerability to external stressors on health and is composed of 4 themes. We evaluated the association between SVI and preeclampsia. Retrospective cohort study of patients delivering at our institution (2014-2018). Patients with only a PO box address were excluded. Patient addresses were transformed into an overall SVI score and a score for each theme. Overall scores were categorized into tertiles (low 0-0.33, moderate 0.34-0.66, high 0.67-1.0). The primary outcome was preeclampsia. We compared rates of preeclampsia across SVI tertiles and estimated adjusted odds (with 95% CIs) using low SVI as the reference group. Mean overall and theme SVI scores (with 95% CIs) were compared between those with and without preeclampsia. Individual components of each theme were compared between groups. 15,228 patients were included: 2,367 (15%) had preeclampsia. There were 4381 (29%) with low, 4350 (28%) moderate, and 6497 (43%) high SVI. Rates of preeclampsia were significantly different between SVI tertile groups; and patients with moderate or high SVI had significantly greater odds of preeclampsia than those with low SVI (aOR 1.4, [1.2-1.6]; aOR 1.4 [1.2-1.6]). Patients with preeclampsia had higher mean SVI scores overall and in socioeconomic status and household composition (Table). They were more likely to be below the poverty level, unemployed, have lower income, have no high school diploma, and to live with people who are disabled or ≥65 (Table). Patients with preeclampsia had lower SVI scores in themes 3 and 4 and were less likely to live in large housing structures and with individuals >5 years who did not speak English well. Patients with preeclampsia live in communities with higher SVI overall and in certain themes. This suggests that the development of preeclampsia is multifactorial. Our interventions to decrease preeclampsia risk should be multifaceted and focus on decreasing healthcare disparities.