Comparison of the Social Vulnerability Index, Area Disadvantage Index, and Social Deprivation Index for Adults With Out-of-Hospital Emergencies

Objectives: Multiple measures are used to assess neighborhood disadvantage. Although each was created with a unique purpose, they share conceptual and methodological overlap. We examined the correlation among 3 measures of neighborhood disadvantage (Social Vulnerability Index SVI, Area Disadvantage Index ADI, and Social Deprivation Index SDI) and their association with quality indicators for adults with prehospital emergencies. Methods: We performed a retrospective analysis using a national multiagency emergency medical services (EMS) database, including emergency scene encounters for adults (aged ≥18 y) with available census-tract SDI and SVI data and census-block ADI data from January 1 through December 31, 2023. We compared the SVI, ADI, and SDI using overall and pairwise intraclass correlation coefficients (ICCs). We evaluated the association of each index with 7 quality indicators for prehospital care developed by the National EMS Quality Alliance. Results: We included 9 259 983 encounters (median IQR age, 63 44-77 y). The overall ICC between indices was 0.65, indicating moderate agreement. We found higher agreement between SVI and SDI (ICC = 0.84) than between SVI and ADI (ICC = 0.54) or ADI and SDI (ICC = 0.59). We found overlap among the indices for most outcomes, although we found differences in ADI associations compared with SVI and SDI for some outcomes. These included bronchodilator use in asthma (SDI/SVI positively associated, ADI not associated), treatment of hypoglycemia (ADI negatively associated, SDI/SVI not associated), and screening of suspected stroke (SDI/SVI negatively associated, ADI not associated). Conclusions: We found moderate agreement among 3 commonly used indices of neighborhood disadvantage. Research is needed to refine the application of these indices to prehospital care and explore their utility in reducing health disparities across health care settings.