Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.
Boston Children's Hospital, Division of Emergency Medicine, Boston, Massachusetts.
West J Emerg Med. 2020 Oct 6;21(6):152-161. doi: 10.5811/westjem.2020.7.47796.
Social risks, or adverse social conditions associated with poor health, are prevalent in emergency department (ED) patients, but little is known about how the prevalence of social risk compares to a patient's reported social need, which incorporates patient preference for intervention. The goal of this study was to describe the relationship between social risk and social need, and identify factors associated with differential responses to social risk and social need questions.
We conducted a cross-sectional study with 48 hours of time-shift sampling in a large urban ED. Consenting patients completed a demographic questionnaire and assessments of social risk and social need. We applied descriptive statistics to the prevalence of social risk and social need, and multivariable logistic regression to assess factors associated with social risk, social need, or both.
Of the 269 participants, 100 (37%) reported social risk, 83 (31%) reported social need, and 169 (63%) reported neither social risk nor social need. Although social risk and social need were significantly associated (p < 0.01), they incompletely overlapped. Over 50% in each category screened positive in more than one domain (eg, housing instability, food insecurity). In multivariable models, those with higher education (adjusted odds ratio [aOR] 0.44 [95% confidence interval {CI}, 0.24-0.80]) and private insurance (aOR 0.50 [95% CI, 0.29-0.88]) were less likely to report social risk compared to those with lower education and state/public insurance, respectively. Spanish-speakers (aOR 4.07 [95% CI, 1.17-14.10]) and non-Hispanic Black patients (aOR 5.00 [95% CI, 1.91-13.12]) were more likely to report social need, while those with private insurance were less likely to report social need (private vs state/public: aOR 0.13 [95% CI, 0.07-0.26]).
Approximately one-third of patients in a large, urban ED screened positive for at least one social risk or social need, with over half in each category reporting risk/need across multiple domains. Different demographic variables were associated with social risk vs social need, suggesting that individuals with social risks differ from those with social needs, and that screening programs should consider including both assessments.
社会风险或与健康不良相关的不利社会条件在急诊科（ED）患者中很常见，但人们对社会风险的流行程度与患者对干预的社会需求（包括患者的偏好）之间的关系知之甚少。本研究的目的是描述社会风险与社会需求之间的关系，并确定与社会风险和社会需求问题的不同反应相关的因素。
我们进行了一项横断面研究，在一家大型城市 ED 进行了 48 小时的时间偏移采样。同意参加的患者完成了人口统计学问卷以及对社会风险和社会需求的评估。我们应用描述性统计方法评估社会风险和社会需求的流行情况，并应用多变量逻辑回归评估与社会风险、社会需求或两者相关的因素。
在 269 名参与者中，有 100 名（37%）报告了社会风险，83 名（31%）报告了社会需求，169 名（63%）既没有社会风险也没有社会需求。尽管社会风险和社会需求显著相关（p < 0.01），但它们并不完全重叠。每个类别中超过 50%的人在一个以上领域筛查呈阳性（例如，住房不稳定、食物不安全）。在多变量模型中，与教育程度较低和州/公共保险相比，受教育程度较高（调整后的优势比[OR] 0.44 [95%置信区间{CI}，0.24-0.80]）和私人保险（调整后的 OR 0.50 [95% CI，0.29-0.88]）的人不太可能报告社会风险。讲西班牙语的人（调整后的 OR 4.07 [95% CI，1.17-14.10]）和非西班牙裔黑人患者（调整后的 OR 5.00 [95% CI，1.91-13.12]）更有可能报告社会需求，而拥有私人保险的人不太可能报告社会需求（私人保险与州/公共保险：调整后的 OR 0.13 [95% CI，0.07-0.26]）。
在一家大型城市 ED 中，约有三分之一的患者至少筛查出一种社会风险或社会需求呈阳性，每个类别中有超过一半的患者报告了多个领域的风险/需求。不同的人口统计学变量与社会风险与社会需求相关，这表明有社会风险的人与有社会需求的人不同，筛查计划应考虑同时进行这两项评估。
