Social Vulnerability Predictors of Acute Care: Leveraging Health Information Exchange Data to Understand Social Determinants at the Census Tract Level in a Correlational Study

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2025-09-29 DOI:10.1002/hsr2.71257

Karen L. Pellegrin, Tanner B. Barbour, Alicia J. Lozano, Alexandra L. Hanlon

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Abstract

Background and Aims

While geographic social vulnerability is a known predictor of acute care utilization, it is not known which specific vulnerabilities are the best predictors. This is particularly important in rural areas where there are significant disparities. The purpose of this study was to identify social vulnerability predictors of acute care utilization across and within rural counties in Hawaiʻi.

Methods

This correlational study examined counts of emergency department (ED) visits and inpatient (IP) admissions for any reason by census tract obtained from Hawaiʻi Health Information Exchange for rural counties in Hawaiʻi. The overall Social Vulnerability Index (SVI), SVI subthemes, and individual measures that comprise the composites were used as measures of social vulnerability for each census tract. Regression models analyzed counts per population, after adjustments for missing data, where the response variable represents the number of events occurring. Each outcome (number of ED or IP visits) was regressed on a single predictor of social vulnerability for each county and for all counties combined.

Results

Across counties, the largest significant effect associated with acute care utilization was overall social vulnerability (ED: IRR = 5.72, 95% CI = 5.55–5.89; IP: IRR = 5.76, 95% CI = 5.42–6.12). The largest effect within Kauaʻi County was Racial and Ethnic Minority Status (ED: IRR = 5.38, 95% CI = 5.13–5.64; IP: IRR = 6.30, 95% CI = 5.64–7.03), within Maui County was Housing Type and Transportation (ED: IRR = 6.72, 95% CI = 6.37–7.1; IP: IRR = 4.46, 95% CI = 3.99–5), and within Hawaiʻi County was Household Characteristics for ED (IRR = 11.50, 95% CI = 10.91–12.12) and No High School Diploma for IP (IRR = 6.33, 95% CI = 5.79–6.93).

Conclusions

Social vulnerability is a significant predictor of acute care utilization across rural areas in Hawaiʻi. The strongest predictors were different for each county.

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急症护理的社会脆弱性预测因素：在一项相关研究中利用健康信息交换数据来理解人口普查区水平的社会决定因素。

背景和目的：虽然地理上的社会脆弱性是已知的急性护理利用的预测因子，但尚不清楚哪些特定的脆弱性是最好的预测因子。这在农村地区尤其重要，因为那里存在着巨大的差距。本研究的目的是确定社会脆弱性的预测因子在急症护理利用跨和在农村县在夏威夷。方法：本相关研究通过夏威夷健康信息交换中心获得的人口普查区对夏威夷农村县急诊（ED）就诊次数和任何原因住院（IP）入院次数进行了调查。使用总体社会脆弱性指数（SVI）、SVI分主题和构成复合指数的个别措施作为每个人口普查区的社会脆弱性措施。在对缺失数据进行调整后，回归模型分析了每个人口的数量，其中响应变量表示发生的事件数量。每个结果（ED或IP访问次数）对每个县和所有县的社会脆弱性的单一预测因子进行回归。结果：在各个县，与急症护理利用相关的最大显著影响是整体社会脆弱性（ED: IRR = 5.72, 95% CI = 5.55-5.89; IP: IRR = 5.76, 95% CI = 5.42-6.12）。最大的影响在Kaua“县是种族和少数民族地位(ED: IRR = 5.38, 95% CI -5.64 = 5.13; IP: IRR = 6.30, 95% CI = 5.64 - -7.03),在毛伊岛县住房类型和交通(ED: IRR = 6.72, 95% CI -7.1 = 6.37; IP: IRR = 4.46, 95% CI = 3.99 5),并在夏威夷县是家庭特征ED (IRR = 11.50, 95% CI = 10.91 - -12.12),没有高中文凭的IP (IRR = 6.33, 95% CI = 5.79 - -6.93)。结论：社会脆弱性是夏威夷农村地区急症护理利用的重要预测因子。每个国家最强的预测因子是不同的。

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