Relationship between a comprehensive social determinants of health screening and type 2 diabetes mellitus

Brady, Elliott; Bridges, Kristina M.; Murray, Megan; Cheng, Huan; Liu, Bing; He, Jia; Woodward, Jennifer

doi:10.1016/j.pmedr.2021.101465

Cited by 8 publications

(10 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We used a survey developed at The University of Kansas Health System (TUKHS), which is a modified version of the validated social needs survey built from the Health Leads Toolkit [ 30 ]. The updates were specific to the separation of personal violence from community violence as those resources may differ [ 31 ]. The survey responses are used by the 12 social workers at TUKHS who aid patients who answer “yes” to any of the social needs questions.…”

Section: Methodsmentioning

confidence: 99%

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing

Mudaranthakam¹,

Pepper²,

Fortney³

et al. 2023

JMIR Public Health Surveill

Self Cite

View full text Add to dashboard Cite

Background Studying patients’ social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people’s social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people’s social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19–related policies aimed to improve. Objective The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Methods Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. Results The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Conclusions Post-COVID-19 responses showed improvement across almost all social needs–related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis.

show abstract

Section: Methodsmentioning

confidence: 99%

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing

Mudaranthakam¹,

Pepper²,

Fortney³

et al. 2023

JMIR Public Health Surveill

Self Cite

View full text Add to dashboard Cite

show abstract

“…As diabetes prevalence rises, so does the number of established and critical diseases in the prevalent population, which could have serious consequences for the quality of life, healthcare demand, and financial costs. End-stage renal disease (ESRD), retinopathy, neuropathy, and lower extremity amputations (LEAs) are among the many burdens associated with diabetes that can be attributed to macrovascular complications such as stroke, coronary heart disease, and peripheral vascular disease, as well as microvascular intricacies like ESRD [ 40 ].…”

Section: Reviewmentioning

confidence: 99%

Complications in Diabetes Mellitus: Social Determinants and Trends

Cuddapah¹,

Chennakesavulu²,

Pentapurthy³

et al. 2022

Cureus

View full text Add to dashboard Cite

Conditions that impact an individual's health are referred to as social determinants of health. Through a retrospective study (January 2017-February 2022) and statistical analysis, researchers looked at the relationship between social demands and type 2 diabetes mellitus (T2DM) diagnosis. All social demands, with the exception of childcare, were more typically documented in patients with T2DM. Prescription expense, conveyance, and health literacy were the domains with the greatest relationships. These results might help health systems and social service providers develop collaborations to help in certain areas.

show abstract

“…To date, most diabetes-related SDOH literature has generally assessed a narrow subset of SDOH challenges at one time [12][13][14][15]. A 2014 systematic review evaluating the impact of SDOH on outcomes for type 2 diabetes mellitus (T2DM) included articles whose focus was mostly clustered around a single SDOH domain: 28 focused on Health and Health Care, 17 on Social and Community Context, 11 on Economic Stability, 3 on Neighborhood and Built Environment, and 1 on Education [12].…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, studies included in a 2021 review by the American Diabetes Association mainly assessed single SDOH domains [ 15 ]. It is less often that a single study evaluates multiple SDOH factors in the same population [ 9 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Social Determinants of Health and Diabetes-Related Distress in Patients With Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach

Levy¹,

Park²,

Solis³

et al. 2022

JMIR Form Res

View full text Add to dashboard Cite

Background Social determinants of health (SDOH) refer to the social, economic, and psychosocial conditions that influence health. Lower levels of SDOH factors including income, education, and employment are associated with a higher prevalence of diabetes, poorer glycemic control, and increased diabetes-related mortality. Few studies have conducted a comprehensive evaluation of multiple SDOH factors in a population with type 2 diabetes mellitus (T2DM). Objective This study aimed to identify the range of SDOH challenges—including diabetes-related distress—that impact patients with insulin-dependent diabetes at an urban safety-net clinic using the 5-domain SDOH framework developed by the Healthy People 2020 initiative. Methods The pilot study used a cross-sectional, mixed methods approach. Participants were recruited from 3 programs within a general internal medicine clinic that provides ambulatory care for patients with uncontrolled T2DM. We administered an investigator-developed SDOH survey based on the Healthy People 2020 framework and the validated Diabetes Distress Scale (DDS), which assesses 4 domains of diabetes-related distress. One-on-one interviews were conducted to gain in-depth information about challenges. Results In total, 57 participants had an average hemoglobin A1c level of 11.0% (SD 2.6%). Overall, 92% (52/57) of participants had a barrier in at least one SDOH domain. SDOH challenges were most commonly reported in the domain of Health and Health Care (84%, 48/57), followed by Economic Stability (54%, n=31), Neighborhood and Built Environment (53%, n=30), Education and Health Literacy (47%, n=27), and Social and Community context (37%, n=21). The mean overall DDS score was 2.09 (SD 0.84), where scores of ≥2 indicate distress. Further, 79% (45/57) of participants had at least moderate diabetes-related distress in one of the 4 DDS domains. General themes that emerged from participant interviews included job interference with healthy behaviors, concerns about burdening others, challenges communicating with providers, and difficulty getting appointments in a timely manner. Conclusions We found high levels of SDOH barriers across all 5 domains of the Center for Disease Control and Prevention’s Healthy People 2020 framework, including significant levels of diabetes-related distress. Future programs to address SDOH barriers in patients with uncontrolled insulin-dependent diabetes should consider screening for and focusing on a wide range of challenges.

show abstract

Relationship between a comprehensive social determinants of health screening and type 2 diabetes mellitus

Abstract: Highlights Most social needs were more commonly reported in patients with T2DM. Prescription cost and transportation had the strongest association with T2DM. Patients diagnosed with T2DM were 1.7X more likely to report any social need.

Cited by 8 publications

References 16 publications

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing

Complications in Diabetes Mellitus: Social Determinants and Trends

Social Determinants of Health and Diabetes-Related Distress in Patients With Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach

Contact Info

Product

Resources

About