The Social Vulnerability Index and Long-Term Outcomes After Traumatic Injury

Juan P. Herrera-Escobar, MD, MPH; Tarsicio Uribe-Leitz, MD, MPH; Joyce Wang, BA; Claudia P. Orlas, MD; Mohamad El Moheb, MD; Taylor E. Lamarre, BA; Niha Ahmad, BS; Ka Man Hau; Molly Jarman, PhD, MPH; Nomi C. Levy-Carrick, MD, MPhil; Sabrina E. Sanchez, MD, MPH; Haytham M. A. Kaafarani, MD, MPH; Ali Salim, MD; Deepika Nehra, MD


Annals of Surgery. 2022;276(1):22-29. 

In This Article

Abstract and Introduction


Objective: The aim of this study was to evaluate the Social Vulnerability Index (SVI) as a predictor of long-term outcomes after injury.

Background: The SVI is a measure used in emergency preparedness to identify need for resources in the event of a disaster or hazardous event, ranking each census tract on 15 demographic/social factors.

Methods: Moderate-severely injured adult patients treated at 1 of 3 level–1 trauma centers were prospectively followed 6 to 14 months post-injury. These data were matched at the census tract level with overall SVI percentile rankings. Patients were stratified based on SVI quartiles, with the lowest quartile designated as low SVI, the middle 2 quartiles as average SVI, and the highest quartile as high SVI. Multivariable adjusted regression models were used to assess whether SVI was associated with long-term outcomes after injury.

Results: A total of 3153 patients were included [54% male, mean age 61.6 (SD = 21.6)]. The median overall SVI percentile rank was 35th (IQR: 16th–65th). compared to low SVI patients, high SVI patients were more likely to have new functional limitations [odds ratio (OR), 1.51; 95% confidence interval (CI), 1.19–1.92), to not have returned to work (OR, 2.01; 95% CI, 1.40–2.89), and to screen positive for post-traumatic stress disorder (OR, 1.56; 95% CI, 1.12–2.17). Similar results were obtained when comparing average with low SVI patients, with average SVI patients having significantly worse outcomes.

Conclusions: The SVI has potential utility in predicting individuals at higher risk for adverse long-term outcomes after injury. This measure may be a useful needs assessment tool for clinicians and researchers in identifying communities that may benefit most from targeted prevention and intervention efforts.


Worldwide, traumatic injury is one of the most common causes of long-term functional impairment and disability.[1] Although long-term outcomes after injury were traditionally understudied, there is now a growing body of evidence that injured patients often struggle with reduced mobility, function, and quality of life even months to years after injury.[2–7] Social determinants of health have a profound impact on an individual's recovery. Worse long-term outcomes and healthcare follow-up after injury have been associated with individual factors, such as lower education level, lower income, female sex, and Black race.[8–10] However, measuring the collective impact of multiple social and societal determinants has proven a more challenging venture.

Beginning in 2011, the Centers for Disease Control and Prevention (CDC) built the Social Vulnerability Index (SVI) as a data-driven tool for capturing "social vulnerability" at the US census tract or county level.[11] Social vulnerability is defined as the potential negative impact on a community caused by the aggregate of demographic, social, and socioeconomic factors. Originally created to improve government response to natural and manmade disasters, SVI is calculated from 15 census variables scattered across the 4 domains of socioeconomic status, household composition, language and minority status, and housing and transportation.[12] It has emerged as a useful single measure of resilience within a community for health-related applications, as it mitigates the concerns of using multiple overlapping proxy variables to assess social determinants of health.[12–14]

Recent literature has leveraged SVI to predict COVID-19 hotspots for both incidence and mortality.[15–17] In the surgical realm, high social vulnerability has been linked to decreased attainment of "textbook outcomes" for cancer, hepatopancreatic, and coronary artery bypass graft operations.[13,18,19] Additionall, higher SVI groups demonstrated greater odds of emergent cholecystectomy and colon resections versus elective cases.[20–22] Although SVI has been sporadically applied to pediatric trauma, there is a dearth of data on the relationship between physical trauma and SVI.[23,24] To date, the association between SVI and long-term outcomes after injury or any surgical condition has not been explored. Therefore, the purpose of this study is to evaluate SVI as a predictor of long-term outcomes following traumatic injury.