Heller Caroline G, Rehm Colin D, Parsons Amanda H, Chambers Earle C, Hollingsworth Nicole H, Fiori Kevin P
Office of Community & Population Health, Montefiore Medical Center, 3154 Dekalb Avenue, Bronx, NY 10467, United States of America.
Office of Community & Population Health, Montefiore Medical Center, 3154 Dekalb Avenue, Bronx, NY 10467, United States of America; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Belfer Building, Bronx, New York 10461, United States of America.
Prev Med. 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752. Epub 2021 Aug 1.
There is consensus that social needs influence health outcomes, but less is known about the relationships between certain needs and chronic health conditions in large, diverse populations. This study sought to understand the association between social needs and specific chronic conditions using social needs screening and clinical data from Electronic Health Records. Between April 2018-December 2019, 33,550 adult (≥18y) patients completed a 10-item social needs screener during primary care visits in Bronx and Westchester counties, NY. Generalized linear models were used to estimate prevalence ratios for eight outcomes by number and type of needs with analyses completed in Summer 2020. There was a positive, cumulative association between social needs and each of the outcomes. The relationship was strongest for elevated PHQ-2, depression, alcohol/drug use disorder, and smoking. Those with ≥3 social needs were 3.90 times more likely to have an elevated PHQ-2 than those without needs (95% CI: 3.66, 4.16). Challenges with healthcare transportation was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. For example, those with transportation needs were 84% more likely to have an alcohol/drug use disorder diagnosis (95% CI: 1.59, 2.13) and 41% more likely to smoke (95% CI: 1.25, 1.58). Specific social needs may influence clinical issues in distinct ways. These findings suggest that health systems need to develop strategies that address unmet social need in order to optimize health outcomes, particularly in communities with a dual burden of poverty and chronic disease.
社会需求会影响健康结果，这一点已达成共识，但对于大型多样化人群中特定需求与慢性健康状况之间的关系，我们了解得还较少。本研究旨在利用社会需求筛查和电子健康记录中的临床数据，了解社会需求与特定慢性病之间的关联。2018年4月至2019年12月期间，33550名成年（≥18岁）患者在纽约州布朗克斯县和韦斯特切斯特县的初级保健就诊期间完成了一项包含10个项目的社会需求筛查。采用广义线性模型，根据需求的数量和类型估计8种结果的患病率比，并于2020年夏季完成分析。社会需求与每种结果之间存在正向的累积关联。这种关系在PHQ-2升高、抑郁症、酒精/药物使用障碍和吸烟方面最为明显。有≥3种社会需求的人PHQ-2升高的可能性是没有需求的人的3.90倍（95%置信区间：3.66, 4.16）。医疗保健交通方面的挑战与每种疾病都有关联，并且在完全调整模型中，是与一半疾病关联最紧密的需求。例如，有交通需求的人被诊断为酒精/药物使用障碍的可能性高84%（95%置信区间：1.59, 2.13），吸烟的可能性高41%（95%置信区间：1.25, 1.58）。特定的社会需求可能以不同的方式影响临床问题。这些发现表明，卫生系统需要制定策略来满足未得到满足的社会需求，以优化健康结果，特别是在贫困和慢性病双重负担的社区。
