(698) Association of CDC Social Vulnerability Index and Postpartum Care Attendance

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Anna P. Staniczenko, MD, MSc

Maternal Fetal Medicine Fellow
Weill Cornell Medical College
New York, New York, United States

Coauthor(s)

Julie Robin Dean, MD

Obstetrics and Gynecology Resident
Weill Cornell Medical College
New York, New York, United States
KV

Kristin M. Voegtline, PhD

Division of Maternal Fetal Medicine, Obstetrics and Gynecology
Weill Cornell Medicine
New York, New York, United States
CR

Caitlin Radford, MD

Resident, Obstetrics and Gynecology
Weill Cornell Medicine
New York, New York, United States
CT

Charlene Thomas, MS

Division of Biostatistics, Department of Population Health Sciences
Weill Cornell Medicine
New York, New York, United States
SY

Steven Yen, MS

Department of Information Technologies & Services
Weill Cornell Medicine
New York, New York, United States
ES

Evan Sholle, MS

Division of Health Informatics, Department of Population Health Sciences
Weill Cornell Medicine
New York, New York, United States
LO

Lauren M. Osborne, MD (she/her/hers)

Department of Obstetrics and Gynecology
Weill Cornell Medicine
New York, New York, United States
JL

Julianne R. Lauring, MD

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology
Weill Cornell Medicine
New York, New York, United States
Heather S. Lipkind, MD, MS (she/her/hers)

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology
Weill Cornell Medicine
New York, New York, United States
Moeun Son, MD, MSCI (she/her/hers)

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology
Weill Cornell Medicine
New York, NY, United States

Objective: Increasing the rate of postpartum follow-up has been identified as a national priority to decrease maternal morbidity and promote maternal health. We sought to evaluate whether there is an association between the CDC’s Social Vulnerability Index (SVI) and postpartum care attendance.

Study Design: This is a retrospective case control study of patients who delivered at >20 weeks’ gestation at any of 3 hospitals within a New York City healthcare system from 1/1/2022 to 2/1/2024 and had at least one prenatal visit at an affiliated site prior to delivery. The outcome of postpartum care was dichotomized as at least one outpatient obstetric visit within 12 weeks of delivery. The exposure was CDC-defined SVI, using a validated technique for geocoding patient addresses to assign overall SVI as well as SVI theme scores. SVI was categorized into quartiles representing low to high social vulnerability; more vulnerable patients have higher SVI scores. Demographic, medical, and obstetric factors were examined, and bivariate and multivariate logistic regressions performed.

Results: A total of 21,864 patients were included. Overall, 89.2% attended their PPV, but 33.3% of those with public insurance and 37.8% of those who delivered at community-based sites did not attend their PPV. Among all patients, the distribution of PPV attendance substantially varied based on SVI quartile (Figure), and the odds of attending at least one PPV significantly decreased as SVI increased in a dose-dependent fashion (Table). These patterns persisted among the socioeconomic, household, and housing/transport themes for SVI (Table). After adjusting for important potential confounders, the significant association between high SVI and decreased odds of attending PPV persisted (aOR 0.72, 95% CI 0.59, 0.88).

Conclusion: Social vulnerability is significantly associated with likelihood of postpartum visit attendance within 12 weeks of delivery: those with the highest vulnerability have the lowest odds of following up for postpartum care. The CDC’s SVI may be an effective screening tool to identify those at risk of loss to follow-up postpartum.