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Health Equity/Community Health

Poster Session 4

(1090) The association of social vulnerability index and trial of labor after cesarean

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Lauren M. Murphy, MD

Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States

Coauthor(s)

NE

Ntami P. Echeng, MD

Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
MS

Matthew M. Scarpaci, MPH

Brown Univeristy School of Public Health
Providence, RI, United States
Margaret Thorsen, BA, MD

Physician
Women and Infants Hospital
Providence, RI, United States
Victoria Adewale, MD (she/her/hers)

Resident Physician
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
John R. Soehl, MD (he/him/his)

Fellow Physician
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
Anna Whelan, MD (she/her/hers)

University of Massachusetts Chan Medical School
Grafton, MA, United States
Alexis C. Gimovsky, MD

Associate Professor
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
Brock E. Polnaszek, MD

Maternal Fetal Medicine Fellow
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States

Objective: The objective of this study was to evaluate the association of the social vulnerability index (SVI) and rates of trial of labor after cesarean section (TOLAC).

Study Design: The number of births per mode of delivery were extracted from the publically available Center for Disease Control and Prevention (CDC) natality WONDER database from 2019-2021. Delivery county’s were linked to nationally ranked county SVI scores from the CDC/SVI. SVI scores were stratified into quartiles with higher quartiles representing greater social vulnerability. Outcomes were rates of elective repeat cesarean (RCD), attempted TOLAC, successful vaginal birth after cesarean (VBAC), and unsuccessful TOLAC.

Results:
Patients who delivered in areas with the highest quartile SVI scores were significantly more likely to undergo an elective RCD (RR 1.04 CI 1.03- 1.05), less likely to achieve a VBAC (RR 0.60 CI 0.50- 0.61), and less likely to undergo a TOLAC (RR 0.71 CI 0.70- 0.72) compared to the lowest quartile. Tests for linear trend across quartiles were significant for RCD, successful VBAC, and attempted TOLAC (P < 0.0001). Rates of unsuccessful TOLAC were not different across SVI quartiles (Figure 1.)

Conclusion: This study demonstrates disparities in mode of delivery illustrated by increased rates of elective RCD and lower rates of VBAC and TOLAC among those delivering in areas of greater social vulnerability. In order to improve cesarean morbidity and increase equity, future studies should assess the cause of these disparities and develop interventions to address them.