College of Pharmacy and Pharmaceutical Sciences, University of Toledo, 3345 Airport Hwy, Apt 7A, Toledo, OH 43609. Email:
Am J Manag Care. 2021 Mar;27(3):115-121. doi: 10.37765/ajmc.2021.88599.
The primary aim was to examine the association of social risks with avoiding/delaying health care after controlling for sociodemographic covariates, and the secondary aim was to examine the association of social risks with emergency department (ED) visits after controlling for avoiding/delaying health care and sociodemographic covariates.
2017 Ohio Medicaid Assessment Survey data were analyzed.
Descriptive, bivariate analysis and multiple weighted logistic regressions were conducted. First, weighted logistic regression assessed the association of aggregated social risk (food insecurity, housing instability, financial strain) and health insurance type with avoiding/delaying health care after controlling for sociodemographic covariates. Next, weighted logistic regression assessed the association of social risks with ED visits after controlling for avoiding/delaying health care and sociodemographic covariates.
Among 39,711 respondents, 21.7% reported avoiding/delaying health care and 27.2% reported having at least 1 ED visit in the past year. Individuals with higher vs lower aggregated social risk had higher odds of avoiding/delaying health care (odds ratio [OR], 1.30; 95% CI, 1.26-1.34) and were more likely to have any ED visits (OR, 1.10; 95% CI, 1.07-1.13). Uninsured individuals compared with those with private insurance were more likely to avoid/delay health care (OR, 1.98; 95% CI, 1.73-2.26) and have higher likelihood of any ED visits (OR, 1.23; 95% CI, 1.06-1.42). Finally, individuals who reported avoiding/delaying getting health care were more likely to have higher odds of any ED visits (OR, 1.33; 95% CI, 1.23-1.45).
Social risks are important factors in patients' decisions to avoid/delay health care and are associated with increased odds of any ED visits. To reduce ED visits, policy-level efforts need to be made to address these social challenges.
本研究旨在控制社会人口学协变量后，检验社会风险与医疗保健回避/延迟之间的关联；并旨在控制医疗保健回避/延迟和社会人口学协变量后，检验社会风险与急诊就诊之间的关联。
分析了 2017 年俄亥俄州医疗补助评估调查数据。
进行了描述性、双变量分析和多重加权逻辑回归。首先，加权逻辑回归评估了综合社会风险（食物不安全、住房不稳定、经济压力）和医疗保险类型与控制社会人口学协变量后医疗保健回避/延迟之间的关联。接下来，加权逻辑回归评估了控制医疗保健回避/延迟和社会人口学协变量后社会风险与急诊就诊之间的关联。
在 39711 名受访者中，21.7%报告回避/延迟医疗保健，27.2%报告在过去一年中有至少 1 次急诊就诊。与社会风险较低的个体相比，社会风险较高的个体更有可能回避/延迟医疗保健（比值比 [OR]，1.30；95%置信区间 [CI]，1.26-1.34），并且更有可能进行任何急诊就诊（OR，1.10；95%CI，1.07-1.13）。与私人保险相比，没有保险的个体更有可能回避/延迟医疗保健（OR，1.98；95%CI，1.73-2.26），并且更有可能进行任何急诊就诊（OR，1.23；95%CI，1.06-1.42）。最后，报告回避/延迟获得医疗保健的个体更有可能具有更高的任何急诊就诊可能性（OR，1.33；95%CI，1.23-1.45）。
社会风险是患者回避/延迟医疗保健决策的重要因素，并且与急诊就诊的可能性增加相关。为了减少急诊就诊，需要在政策层面上努力解决这些社会挑战。
