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Greater social determinants of health burden associated with an increased risk of hospitalization
Clinical Question
What is the association between social determinants of health and hospital utilization?
Bottom line
SDOH have a known impact on health outcomes. This study showed that a greater cumulative SDOH burden for an individual was associated with an increased risk of hospitalization. Specifically, food insecurity, social isolation, and educational deficits were all associated with a higher risk of hospitalization. Recognizing and mitigating these risks, even in the inpatient setting, will be important in efforts to reduce hospital utilization. 2c
Reference
Study design: Cross-sectional
Funding: Government
Setting: Outpatient (any)
Synopsis
These investigators used data from the 2016–2018 National Health Interview Survey of community-dwelling people in the United States. Of the 55,816 respondents (after limiting the sample to adults only and excluding those with missing data on hospitalization), approximately half were 50 years or younger and female, 84% were non-Hispanic, 78% were White, and 90% had health insurance. Commonly reported health conditions included hypertension, chronic pain, and obesity. All 6 domains of social determinants of health (SDOH) were present in the cohort per self-report: educational deficits (61%), economic instability (27%), social isolation (24%), poor access to health care (13%), lack of community (10%), and food insecurity (9%). Overall, 10% of the cohort reported a hospitalization in the past 12 months. In the adjusted analyses, 3 SDOH domains were associated with an increased risk of hospitalization, including food insecurity (odds ratio [OR] 1.36; 95% CI 1.22 - 1.52), social isolation (OR 1.17; 1.08 - 1.26), and educational deficits (OR 1.12; 1.02 - 1.25). Further, when compared with individuals who reported no SDOH, a higher SDOH burden was associated with a greater risk of hospitalization (3 or 4 SDOH: OR 1.25; 1.06 - 1.49; 5 or more SDOH: OR 1.72;1.40 - 2.06).
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
SDOH and risk of hospitalization
Although it seems intuitive that people with stressors related to SDOH would be at higher risk it is very useful to see this quantified. It is also intuitive that our focus might be better placed on improving SDOH rather than worrying how strictly the latest clinical guideline for "condition x" is being applied. Can we be brave enough to actually include addressing SDOH issues in guidelines themselves?
SDOH & Hospitalisation
Stating the obvious - though a 61% 'educational deficits' needs clarification & quantifying.
Social status and Health
Clear connection between health and socioeconomic status