Toward Understanding Social Needs Among Primary Care Patients With Uncontrolled Diabetes

Abstract

Introduction/Objectives: Uncontrolled diabetes can lead to major health complications, and significantly contributes to diabetes-related morbidity, mortality, and healthcare costs. Few studies have examined the relationship between unmet social needs and diabetes control among predominantly Black and Hispanic patient populations. Methods: In a large urban hospital system in the Bronx, NY, 5846 unique patients with diabetes seen at a primary care visit between April 2018 and December 2019 completed a social needs screener. Measures included diabetes control (categorized as Hemoglobin (Hb) A1c <9.0 as controlled and Hb A1C ≥9.0 as uncontrolled), social needs (10-item screen), and demographic covariates, including age, sex, race/ethnicity, insurance status, percentage of block-group poverty, patient’s preferred language, and the Elixhauser Comorbidity Index. Results: Twenty-two percent (22%) of the patient sample had at least 1 unmet social need, and the most prevalent unmet social needs were housing issues (including housing quality and insecurity), food insecurity, and lack of healthcare transportation. Logistic regression analysis showed a significant relationship between social needs and uncontrolled diabetes, with more social needs indicating a greater likelihood of uncontrolled diabetes (Adjusted Odds Ratio (AOR) for ≥3 needs: 1.59, 95% CI: 1.26, 2.00). Of the patients with most frequently occurring unmet social needs, lack of healthcare transportation (AOR: 1.54, 95% CI: 1.22, 1.95) and food insecurity (AOR: 1.50, 95% CI: 1.19, 1.89) had the greatest likelihood of having uncontrolled diabetes, after adjusting for covariates. Conclusion: Unmet social needs appear to be linked to a greater likelihood of uncontrolled diabetes. Implications for healthcare systems to screen and address social needs for patients with diabetes are discussed.

WITHDRAWN: Implementing Health Related Social Needs Screening in an Outpatient Clinic: A Cross-Sectional Study

“…Literature to date has demonstrated that having such comorbidity tends to correlate with reporting of more than one social need. (1)(2)(3)33) This is the rst study to our knowledge to suggest that HRSN screening may predispose to intentionally screening patients with more comorbidity.…”

Predicting health-related social needs in Medicaid and Medicare populations using machine learning

“…SDOHs are broader upstream social conditions in which people are born, live, and work while social needs are more immediate and downstream individual or family needs impacted by the conditions 1 , 2 . Social needs such as food insecurity have been associated with depression 3 , diabetes distress 3 , and chronic health conditions 4 – 7 . Similarly, children who experience energy insecurity (i.e., inability to obtain energy to heat or cool one’s home) in their household are at an increased odds of food insecurity, hospitalization, and poor health 8 .…”

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

“…Unmet social risk factors like lack of access to health insurance, food insecurity, and housing instability create barriers to managing diabetes and are major drivers of poor glycemic control [ 7 ]. Prior to the pandemic, these risk factors drove much of the inequities observed in diabetes morbidity and mortality across sociodemographic groups in the US [ [7] , [8] , [9] ]. Unmet basic needs are highly prevalent, even among patients who are insured, and are associated with poor diabetes-related clinical outcomes [ 8 , 8 , 9 ].…”