Office of Community & Population Health, Montefiore Medical Center, Bronx, New York.
Office of Community & Population Health, Montefiore Medical Center, Bronx, New York; Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Am J Prev Med. 2020 Apr;58(4):514-525. doi: 10.1016/j.amepre.2019.11.011.
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.
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.
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.
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.
越来越多的卫生系统希望通过社会风险筛查来解决健康的社会决定因素。本研究的目的是了解在纽约布朗克斯区一个大型城市卫生系统的常规筛查中，所有患者和人群亚组中社会风险的数量和类型的变化情况。
2018 年 4 月至 12 月期间，共有 24633 名初级保健患者在该系统的 19 个门诊站点完成了 10 项筛查。总体上和按人群亚组估计了任何社会风险和特定社会风险的流行率。采用 Wald 检验确定亚组之间的统计学显著差异。数据于 2019 年冬春季进行分析。
20%的患者至少存在 1 种社会风险。报告频率最高的风险包括住房质量（6.5%）和粮食不安全（6.1%）。与 18-29 岁的患者相比，中年（30-59 岁）患者（24.7%，95%CI=23.6%，25.7%）（24.8%，95%CI=24.0%，25.5%）更有可能报告社会风险，而与商业保险患者相比，医疗补助患者（24.8%，95%CI=24.0%，25.5%）（11.8%，95%CI=11.1%，12.5%）。住房质量风险的最强预测因素是居住在公共住房（15.1%，95%CI=13.8%，16.6%），而不是居住在公共住房（5.6%，95%CI=5.3%，5.9%），p<0.001）。住房质量是<18 岁儿童和≥70 岁老年人中报告频率最高的风险，而对于 30-69 岁的中年患者，其风险是粮食不安全。
按亚组划分，总体和个体社会风险的流行率存在重要差异。这些发现应作为临床护理和社会风险筛查和干预的依据。
