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Am J Perinatol
DOI: 10.1055/a-2779-7215
Original Article

The Relationship between Social Vulnerability Index, Area Deprivation Index, and Child Opportunity Index, and Treatment Course Characteristics in Infants with Surgically Intervenable Congenital Anomalies

Authors

  • Ryan D. Bigej

    1   Department of Psychiatry, Duke University, Durham, North Carolina, United States

  • Devlynne S. Ondusko 

    2   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, United States

  • Ali Oran

    3   Department of Surgery, Oregon Health and Science University, Portland, Oregon, United States

  • Lucy Ward

    4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States

  • Natalie Beatie

    5   Oregon Health and Science University School of Medicine, Portland, Oregon, United States

  • Tatiana K. Jenkins

    5   Oregon Health and Science University School of Medicine, Portland, Oregon, United States

  • Andrew H. Chon

    4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States

  • Mónica Rincón 

    4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, United States

  • Raphael C. Sun 

    3   Department of Surgery, Oregon Health and Science University, Portland, Oregon, United States
    6   Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, United States

Funding Information This project was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through grant (grant number: UL1TR002369). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

Objective

The social vulnerability index (SVI) is a place-based index used to stratify community risk. We evaluated the impact of SVI on pregnancy and infant outcomes in patients with surgically treatable congenital anomalies.

Study Design

This is a retrospective study of pregnant patients and infant dyads diagnosed from 2014 to 2022 with congenital anomalies amenable to surgical treatment. Dyads were grouped into SVI quartiles. Primary outcomes were infant morbidity and mortality, and secondary outcomes included prenatal care services, pregnancy course characteristics, and pregnant person co-morbidities. The area deprivation index and child opportunity index were also collected. Bivariate comparisons of patient characteristics and unadjusted odds ratios for death or morbidity stratified by SVI quartile were performed.

Results

Two hundred and ninety-five dyads met the inclusion criteria. Ten point two percent had low SVI, 23.7% low–medium, 35.3% medium–high, and 30.9% high. The only prenatal care service associated with SVI quartile was fetal MRI (p = 0.038), but no directional trend was observed. Infant diagnoses included 11.5% congenital diaphragmatic hernia, 27.5% gastroschisis, 18.6% intestinal atresia, 9.2% lower urinary tract obstruction, 20.3% myelomeningocele, 9.2% omphalocele, 0.3% sacrococcygeal teratoma, 8.5% tracheoesophageal fistula. The odds ratio of poor infant outcomes by SVI quartile showed a nonsignificant elevated odds ratio in the highest quartile SVI (low–medium SVI OR: 0.66 [95% CI: 0.14, 2.35], medium–high SVI OR: 0.78 [95% CI: 0.17, 2.63], and high SVI OR: 1.57 [95% CI: 0.32, 6.4]).

Conclusion

SVI quartile was not associated with infant outcomes in patients with surgically treatable congenital anomalies. Future studies should examine the impact of SVI or other indices of social vulnerability on perinatal and long-term postnatal outcomes in these high-risk patients.

Key Points

  • Healthcare inequities warrant exploration in congenital surgical pathologies.

  • Explored SVI quartile association with infant outcomes.

  • Primary outcomes were not associated with SVI quartile.

  • Nonsignificantly higher odds of poor outcome in patients with high SVI quartile.

Keywords

congenital anomalies - structural determinants of health - racism - social vulnerability index - neonatal outcomes - health equity

Data Availability Statement

In the interest of pursuing transparency and efficiency in the research community, our data are available for review. To maintain the protected health information of the subjects of this research, all identifiers and dates have been removed from the dataset.




Publication History

Received: 18 August 2025

Accepted: 24 December 2025

Article published online:
20 January 2026

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