Social Risks Among Primary Care Patients in a Large Urban Health System

Abstract

Introduction: Health systems are increasingly interested in addressing the social determinants of health via social risk screening. The objective of this study is to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system. Methods: Between April and December 2018, a total of 24,633 primary care patients completed a 10-item screener across 19 ambulatory sites within a health system in the Bronx, NY. The prevalence of any social risk and specific social risks was estimated overall and for population subgroups. Wald tests were used to determine statistically significant differences by subgroup. Data were analyzed in winter/spring 2019. Results: Twenty percent of patients presented with at least 1 social risk. The most frequently reported risks included housing quality (6.5%) and food insecurity (6.1%). Middle-aged (30-59 years) respondents (24.7%, 95% CI=23.6%, 25.7%) compared with those aged 18-29 years (17.7%, 95% CI=16.4%, 19.2%, p<0.001), and Medicaid patients (24.8%, 95% CI=24.0%, 25.5%) compared with commercially insured patients (11.8%, 95% CI=11.1%, 12.5%, p<0.001), were more likely to report social risks. The strongest predictor of housing quality risk was residing in public housing (15.1%, 95% CI=13.8%, 16.6%) compared with those not in public housing (5.6%, 95% CI=5.3%, 5.9%, p<0.001). Housing quality was the most frequently reported risk for children (aged <18 years) and older adults (aged ≥70 years), whereas, for middle-aged respondents (30-69 years), it was food insecurity. Conclusions: There are important differences in the prevalence of overall and individual social risks by subgroup. These findings should be considered to inform clinical care and social risk screening and interventions.

Toward Understanding Social Needs Among Primary Care Patients With Uncontrolled Diabetes

“…23 There is a growing body of evidence from our group and others that unmet social needs are associated with increased chronic conditions and poorer health care access. 24 , 25 In our patient sample, approximately 10% of patients have 2 or more unmet social needs (similar prevalence in a larger hospital system sample 18 ). The dose-response relationship of multiple unmet social needs on diabetes control shown in this study suggests a compounding effect of social needs on diabetes control.…”

“…Unmet social needs were measured using a 10-item screening tool adapted from the Health Leads’ instrument (described elsewhere.) 18 Briefly, the 10 items focused on actionable items which could be addressed by connecting patients to resources. Social needs data were only available for patients who visited clinics where screening practices were implemented.…”

“… 16 , 17 In prior work, patients experiencing more social needs were more likely to miss follow-up appointments. 18 Other studies have shown that individuals experiencing housing insecurity, for example, were more likely to report worse health and delays in medical care. 19 Food insecurity is linked to worse diabetes-related symptoms and medication rationing, 20 and deciding between buying food or buying medication.…”

“…Data from a large urban hospital system of predominantly Black and Hispanic patients shows that approximately 20% of screened patients have one or more unmet social needs. 18 The objective of this study was to examine whether unmet social needs, and specific social need categories, were associated with uncontrolled diabetes among adults in a large urban health system.…”

Chronic pediatric health conditions among youth living in public housing and receiving care in a large hospital system in Bronx, NY

“…Identifying the housing-related needs of young patients is a necessary step to developing clinical-community partnerships to improve health among residents. 9,43,44…”