Department of Management, Policy and Community Health Practice, UTHealth School of Public Health, RAS 1017, 1200 Pressler St, Houston, TX 77030. Email:
Am J Manag Care. 2021 Mar 1;27(3):e89-e96. doi: 10.37765/ajmc.2021.88603.
This study explored the contributions of social determinants of health (SDOH) to measures of population health-specifically cost, hospitalization rates, rate of emergency department utilization, and health status-in Texas.
The study associated common SDOH metrics from public data sources (county specific) with health plan enrollment data (including demographics, counties, and zip codes) and medical and pharmaceutical annual claims data.
Following correlation analyses to reduce variables, the contribution of each SDOH individually and by category to the health outcomes was evaluated. Separate matrices for age populations (under age 19, general population [all ages], and ≥ 65 years) were created with assigned weights of influence for categories and the factors within each category.
The contributions of the categories varied by population, confirming that different SDOH influence populations to varying degrees. This was reflected in each model. The largest contributor to cost for the general population and for the group 65 years and older was factors grouped as health outcomes (such as perceived health), at 43.5% contribution and 37.7% contribution, respectively. Yet for the population younger than 19 years, the largest contributor to cost was socioeconomic factors (such as unemployment rate), at 40.2%. The other performance measures also varied by population and the mix and weight of determinants.
This study and the developed population-based matrices can provide a valuable framework for reporting the impact of SDOH on health care quality. The variation suggests the need for further research on how age groups react to the social environment.
本研究探讨了健康的社会决定因素（SDOH）对德克萨斯州特定人群健康指标（具体为成本、住院率、急诊利用率和健康状况）的影响。
本研究将公共数据源（县特定）中的常见 SDOH 指标与健康计划参与数据（包括人口统计学、县和邮政编码）以及医疗和药品年度理赔数据相关联。
对变量进行相关分析以减少变量后，评估每个 SDOH 单独和按类别对健康结果的贡献。为年龄群体（19 岁以下、普通人群[所有年龄段]和≥65 岁）创建单独的矩阵，并为类别和每个类别中的因素分配影响权重。
各群体的类别贡献因人口而异，这证实了不同的 SDOH 对不同人群的影响程度不同。这在每个模型中都有所体现。对普通人群和 65 岁及以上人群的成本影响最大的因素是健康结果类别的因素（如感知健康），分别为 43.5%和 37.7%的贡献。然而，对于 19 岁以下的人群，成本的最大贡献因素是社会经济因素（如失业率），占 40.2%。其他绩效指标也因人口以及决定因素的组合和权重而异。
本研究和开发的基于人群的矩阵可以为报告 SDOH 对医疗保健质量的影响提供有价值的框架。这种变化表明需要进一步研究不同年龄组对社会环境的反应。
