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Supplemental Digital Content 2. Mediation Model Effects* for Resource Use Outcomes: Using SVI Themes 1-4 (N = 147,496)

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= 147,496)

Dependent Variable

(# of) Predictor Effect IRR 95% CI

HCCs SVI Theme 1: Socioeconomic Status Effect of SVI Theme 1 on HCCs 1.51 (1.46, 1.56)

SVI Theme 2: Household Composition &

Disability Effect of SVI Theme 2 on HCCs 1.51 (1.45, 1.57)

SVI Theme 3: Minority Status & Language Effect of SVI Theme 3 on HCCs 1.54 (1.46, 1.62)

SVI Theme 4: Housing & Transportation Effect of SVI Theme 4 on HCCs 1.22 (1.16, 1.28)

Hospitalizations SVI Theme 1: Socioeconomic Status Direct effect of SVI Theme 1 on hospitalizations 1.51 (1.35, 1.68)

Effect of HCCs on hospitalizations 1.50 (1.47, 1.52)

Effect of SVI Theme 1 on hospitalizations mediated by HCCs 1.12 (1.03, 1.47) Total effect of SVI Theme 1 on hospitalizations 1.69 (1.46, 2.24)

Proportion of total effect mediated 0.22 (0.07, 0.51)

ED Visits Direct effect of SVI Theme 1 on ED visits 2.19 (2.00, 2.40)

Effect of HCCs on ED visits 1.21 (1.19, 1.23)

Effect of SVI Theme 1 on ED visits mediated by HCCs 1.05 (1.01, 1.18)

Total effect of SVI Theme 1 on ED visits 2.31 (2.06, 2.65)

Proportion of total effect mediated 0.06 (0.02, 0.17)

Observation Stays Direct effect of SVI Theme 1 on observation stays 1.95 (1.62, 2.34)

Effect of HCCs on observation stays 1.40 (1.36, 1.44)

Effect of SVI Theme 1 on observation stays mediated by HCCs 1.10 (1.02, 1.45) Total effect of SVI Theme 1 on observation stays 2.14 (1.76, 2.92)

Proportion of total effect mediated 0.12 (0.04, 0.34)

Total Visits Direct effect of SVI Theme 1 on total visits 1.99 (1.86, 2.17)

Effect of HCCs on total visits 1.34 (1.32, 1.36)

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Dependent Variable

(# of) Predictor Effect IRR 95% CI

Effect of SVI Theme 1 on total visits mediated by HCCs 1.09 (1.02, 1.67)

Total effect of SVI Theme 1 on total visits 2.16 (1.94, 3.32)

Proportion of total effect mediated 0.11 (0.03, 0.43)

Hospitalizations SVI Theme 2: Household Composition &

Disability Direct effect of SVI Theme 2 on hospitalizations 0.96 (0.83, 1.11)

Effect of HCCs on hospitalizations 1.50 (1.48, 1.53)

Effect of SVI Theme 2 on hospitalizations mediated by HCCs 1.13 (1.03, 1.59) Total effect of SVI Theme 2 on hospitalizations 1.08 (0.88, 1.57)

Proportion of total effect mediated NA NA

ED Visits Direct effect of SVI Theme 2 on ED visits 0.90 (0.81, 1.04)

Effect of HCCs on ED visits 1.22 (1.20, 1.24)

Effect of SVI Theme 2 on ED visits mediated by HCCs 1.06 (1.01, 1.26)

Total effect of SVI Theme 2 on ED visits 0.95 (0.84, 1.20)

Proportion of total effect mediated NA NA

Observation Stays Direct effect of SVI Theme 2 on observation stays 0.91 (0.75, 1.10)

Effect of HCCs on observation stays 1.41 (1.37, 1.44)

Effect of SVI Theme 2 on observation stays mediated by HCCs 1.10 (1.03, 1.61) Total effect of SVI Theme 2 on observation stays 1.01 (0.82, 1.42)

Proportion of total effect mediated NA NA

Total Visits Direct effect of SVI Theme 2 on total visits 0.93 (0.85, 1.03)

Effect of HCCs on total visits 1.35 (1.33, 1.36)

Effect of SVI Theme 2 on total visits mediated by HCCs 1.09 (1.02, 1.34)

Total effect of SVI Theme 2 on total visits 1.01 (0.88, 1.29)

Proportion of total effect mediated NA NA

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Hospitalizations SVI Theme 3: Minority Status & Language Direct effect of SVI Theme 3 on hospitalizations 1.59 (1.36, 1.88)

Effect of HCCs on hospitalizations 1.50 (1.47, 1.53)

Effect of SVI Theme 3 on hospitalizations mediated by HCCs 1.13 (1.03, 1.94) Total effect of SVI Theme 3 on hospitalizations 1.79 (1.47, 2.92)

Proportion of total effect mediated 0.21 (0.05, 0.59)

ED Visits Direct effect of SVI Theme 3 on ED visits 1.92 (1.69, 2.19)

Effect of HCCs on ED visits 1.21 (1.20, 1.23)

Effect of SVI Theme 3 on ED visits mediated by HCCs 1.06 (1.01, 1.20)

Total effect of SVI Theme 3 on ED visits 2.03 (1.76, 2.41)

Proportion of total effect mediated 0.08 (0.02, 0.23)

Observation Stays Direct effect of SVI Theme 3 on observation stays 1.62 (1.22, 2.13)

Effect of HCCs on observation stays 1.41 (1.37, 1.44)

Effect of SVI Theme 3 on observation stays mediated by HCCs 1.11 (1.03, 1.40) Total effect of SVI Theme 3 on observation stays 1.79 (1.34, 2.55)

Proportion of total effect mediated 0.17 (0.05, 0.42)

Total Visits Direct effect of SVI Theme 3 on total visits 1.89 (1.68, 2.10)

Effect of HCCs on total visits 1.34 (1.33, 1.36)

Effect of SVI Theme 3 on total visits mediated by HCCs 1.09 (1.02, 1.47)

Total effect of SVI Theme 3 on total visits 2.06 (1.79, 2.75)

Proportion of total effect mediated 0.12 (0.03, 0.37)

Hospitalizations SVI Theme 4: Housing & Transportation Direct effect of SVI Theme 4 on hospitalizations 1.52 (1.20, 1.79)

Effect of HCCs on hospitalizations 1.50 (1.48, 1.53)

Effect of SVI Theme 4 on hospitalizations mediated by HCCs 1.06 (1.01, 1.22)

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Dependent Variable

(# of) Predictor Effect IRR 95% CI

Total effect of SVI Theme 4 on hospitalizations 1.61 (1.32, 1.95)

Proportion of total effect mediated 0.12 (0.03, 0.33)

ED Visits Direct effect of SVI Theme 4 on ED visits 3.24 (2.83, 3.72)

Effect of HCCs on ED visits 1.21 (1.20, 1.23)

Effect of SVI Theme 4 on ED visits mediated by HCCs 1.03 (1.01, 1.16)

Total effect of SVI Theme 4 on ED visits 3.33 (2.90, 4.13)

Proportion of total effect mediated 0.02 (0.01, 0.11)

Observation Stays Direct effect of SVI Theme 4 on observation stays 2.05 (1.63, 2.72)

Effect of HCCs on observation stays 1.40 (1.37, 1.44)

Effect of SVI Theme 4 on observation stays mediated by HCCs 1.05 (1.01, 1.17) Total effect of SVI Theme 4 on observation stays 2.15 (1.66, 2.85)

Proportion of total effect mediated 0.06 (0.01, 0.19)

Total Visits Direct effect of SVI Theme 4 on total visits 2.54 (2.25, 2.89)

Effect of HCCs on total visits 1.34 (1.33, 1.36)

Effect of SVI Theme 4 on total visits mediated by HCCs 1.04 (1.01, 1.19)

Total effect of SVI Theme 4 on total visits 2.65 (2.34, 3.08)

Proportion of total effect mediated 0.04 (0.01, 0.17)

Note: HCCs = Hierarchical Condition Categories based on yearly average from 2015-2016; SVI = Social Vulnerability Index; IRR = Incidence Rate Ratio; CI = Confidence Interval; NA = No mediation demonstrated. *All models adjusted for demographic characteristics (age, gender, race, language), number of prescribed medications, and primary care site characteristics (number of: full-time employees, full-time advanced practice providers, actual visits, active patients).

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on the relationship between Social Vulnerability Index (SVI) Theme 1 and resource use outcomes (A-D for

hospitalizations, ED visits, observation stays, and total visits)

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Supplemental Digital Content 4. Mediation model effects of number of Hierarchical Condition Categories (HCCs) on the relationship between Social Vulnerability Index (SVI) Theme 2 and resource use outcomes (A-D for

hospitalizations, ED visits, observation stays, and total visits)

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on the relationship between Social Vulnerability Index (SVI) Theme 3 and resource use outcomes (A-D for

hospitalizations, ED visits, observation stays, and total visits)

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Supplemental Digital Content 6. Mediation model effects of number of Hierarchical Condition Categories (HCCs) on the relationship between Social Vulnerability Index (SVI) Theme 4 and resource use outcomes (A-D for

hospitalizations, ED visits, observation stays, and total visits)

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