SUN-595 Impact of County-Level Social Vulnerability on Preventable Diabetes-Related Hospitalization in California

Abstract Disclosure: B. Biney: None. Background: Diabetes mellitus results in 8 million hospitalizations each year in the US, some of which can be prevented with good ambulatory care. Diabetes-related preventable hospitalizations (DRPH) are associated with low socioeconomic status and the Social Vulnerability Index (SVI) is a framework for studying the impact of social vulnerability on health outcomes at the county level. However, there is paucity of data on the impact of social vulnerability on DRPH. Objective: To examine the association between county-level SVI and DRPH focusing on short-term complications, long-term complications, lower extremity amputations, and uncontrolled diabetes in California. Method: In this retrospective cross-sectional study, we linked DRPH for patients aged ≥20 years in 2022 with SVI data from the CDC for all counties in California. The SVI is based on 16 social attributes related to socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation. SVI values from 2022 were assigned percentiles from 0 to 1, with higher values indicating greater social vulnerability. SVI percentile rankings were divided into four quartiles (0-0.25 as 1st quartile [SVI-Q1] and least vulnerable, and 0.75-1.00 as SVI-Q4 and most vulnerable). Risk-adjusted hospitalization rate per 100,000 with 95% confidence intervals (CI) were stratified by the SVI quartiles. A negative impact by SVI was characterized by a higher risk-adjusted rate in SVI Q4 than in the SVI Q1 with non-overlapping CI. Rate differences were expressed as excess or fewer hospitalizations per 100,000 and derived by obtaining the differences in SVI Q4 and SVI Q1 for each complication under study. Results: For short-term complications and uncontrolled diabetes, there was no significant difference between SVI-Q4 and SVI-Q1. In contrast, SVI-Q4 had a significantly higher hospitalization rate for long-term complications (114.7; CI: 98.1-131.3) compared to SVI-Q1 (71.5; CI: 54.9-88.1), resulting in 43.2 per 100,000 excess hospitalizations. For lower extremity amputation, SVI-Q4 was significantly higher (40.7; CI: 33.9-47.5) than SVI-Q1 (26.7: CI: 19.8-33.3) and this resulted in an excess of 14 per 100,000 hospitalizations in SVI-Q4. Lastly, for diabetes composite (any hospitalization for any of the four complications), the DRPH was 170.1 (CI: 137.4-202.8) in SVI-Q1 and 240 (CI: 207.6-273) in SVI-Q4, respectively, which yielded an excess of 70 hospitalizations. Conclusion: Higher county-level social vulnerability is associated with increased DRPH in California. The allocation of more resources to counties with higher SVIs can potentially reduce DRPH in these counties. Presentation: Sunday, July 13, 2025