Clinical Insights and Social Vulnerability in Infantile Hemangiomas: A 10-Year Retrospective Cohort in Puerto Rico

Infantile hemangiomas (IHs) are the most common benign vascular tumors in childhood.While most occurrences regress spontaneously, some require treatment due to ulceration, functional impairment, or cosmetic concerns.In Puerto Rico, social determinants of health potentially affect both access to healthcare and clinical outcomes.The Social Vulnerability Index (SVI), a composite metric encompassing socioeconomic status, household composition, transportation, and other social factors, is commonly used to evaluate community-level vulnerability.This study sought to describe lesion location and treatment modalities, and evaluate whether the SVI is associated with treatment outcomes in IH patients in Puerto Rico as measured by lesion size at presentation, follow-up, and change in lesion size following treatment.Records of pediatric patients diagnosed with hemangiomas between 2015 and 2025 were retrospectively reviewed.A total of 30 patients were identified, and extracted data included patient demographics, treatment modality, lesion location, and lesion size, as measured via a flexible measuring tape, before and after treatment.SVI was calculated and assigned according to patients' residential Zone Improvement Plan (ZIP) code and matched to the corresponding SVI values obtained from the Agency for Toxic Substances and Disease Registry (ATSDR) database at the time of presentation.Most patients (43.3%) were treated with propranolol, followed by surgical resection or embolization (20%).The most affected areas were the limbs (50%) and the head and neck (30%) region.Using Spearman's rank correlation, the study found that a higher SVI was associated with a larger hemangioma lesion size at presentation (Spearman's rho = 0.681, p = 0.005) and remained correlated with a larger post-treatment lesion size (Spearman's rho = 0.634, p = 0.011).However, the SVI was not associated with the magnitude of size reduction following treatment (Spearman's rho = 0.09, p = 0.742), meaning that the disparities in lesion size are likely due to differences in disease severity at the time of diagnosis rather than differences due to treatment response.Meanwhile, results also suggest that since more than half of patients were managed with pharmacologic therapy, treatment compliance may play an important role in influencing outcomes.Ultimately, SVIs could be used to flag patients who may present later or with larger lesions in order to enable earlier monitoring and management.