Comparative utility of median household income, social vulnerability index, and social deprivation index in predicting heart failure-related emergency department revisits: A multi-hospital cohort study

Background HF-related emergency department (ED) revisits are clinically meaningful markers of post-discharge decompensation, imposing substantial burden on patients and health systems. The comparative utility of the Social Vulnerability Index (SVI) and Social Deprivation Index (SDI) versus median household income in predicting revisits remains unclear. Objectives To compare ZIP code-level median household income, SVI, and SDI in predicting 6-month HF-related ED revisits. Methods Retrospective cohort of 955 adults with index ED encounters for HF across three hospitals (2019–2024). ZIP codes were linked to median household income, SVI, and SDI. Each measure was evaluated in separate adjusted logistic regression models and in a joint model; variance inflation factors (VIF) quantified collinearity. Results Six-month revisits occurred in 42.9% (410/955; mean age 63.3 ± 15.7 years, 61.8% male). All three measures predicted revisit risk (income Q4 vs Q1: OR 0.36, 95% CI 0.24–0.52; SVI Q4: OR 2.44, 95% CI 1.20–4.95; SDI Q4: OR 2.49, 95% CI 1.70–3.66). Separate adjusted models showed nearly identical discrimination (AUC: income 0.646, SDI 0.645, SVI 0.636). In the joint model, SVI and SDI were attenuated by collinearity (VIF >9), while income retained significance (OR 0.34, 95% CI 0.15–0.78, p=0.011). Black race predicted higher revisit risk (OR 1.57, p=0.016); income gradients were strongest in women (Q4 OR 0.29) and patients <65 years (Q4 OR 0.30). Conclusion All three measures capture overlapping socioeconomic signals with equivalent discrimination. SVI and SDI attenuation in joint models reflects statistical redundancy rather than true inferiority; income's parsimony supports its use as a practical screening tool at discharge.