Jones Kyle G, Roth Sarah E, Vartanian Keri B
Center for Outcomes Research and Education (CORE), Providence Health and Services, Portland, Oregon, USA.
Popul Health Manag. 2022 Apr;25(2):218-226. doi: 10.1089/pop.2021.0255. Epub 2021 Dec 17.
Understanding health outcomes and patterns of health care utilization associated with patients' cumulative social determinant of health (SDOH) risk is essential to supporting better health care. This study compared mental and physical health outcomes and health care utilization by increasing number of social needs among a clinical adult population. Surveys were sent to 6000 patients with recent visits to 7 primary care clinics in Portland, Oregon in 2018. The final study sample included respondents who matched to medical claims data, = 1748. The authors used a modified logistic regression model to estimate risk ratios for the relationship between cumulative SDOH factors and self-reported chronic conditions, and a 2-part model to estimate the effects of cumulative SDOH risk on health care utilization. Increased SDOH need was associated with increasing likelihood of worse self-reported health outcomes, especially mental health. Compared with those with no SDOH need, having 1-2 SDOH need(s) (adjusted risk ratio [aRR] 1.25; 95% confidence interval [CI]: 1.06-1.46) and 3 or more SDOH needs (aRR 1.45; 95% CI: 1.22-1.73) had a greater risk of reporting any behavioral health condition. However, the number of SDOH had a graded but inverse impact on use of mental health care services where fewer visits were observed among those using care. Having SDOH was associated with increased likelihood of having an emergency department visit and increased number of primary care visits. This study demonstrates the compounding impact of SDOH on health and health care use. This highlights the importance of collecting SDOH, including the total number of SDOH needs, when considering a patient's health and health care.
了解与患者累积健康社会决定因素（SDOH）风险相关的健康结果和医疗保健利用模式对于支持更好的医疗保健至关重要。本研究比较了临床成年人群中随着社会需求数量增加而产生的心理健康和身体健康结果以及医疗保健利用情况。2018年，研究人员向俄勒冈州波特兰市7家初级保健诊所近期就诊的6000名患者发送了调查问卷。最终的研究样本包括与医疗理赔数据匹配的受访者，共1748人。作者使用改良的逻辑回归模型来估计累积SDOH因素与自我报告的慢性病之间关系的风险比，并使用两部分模型来估计累积SDOH风险对医疗保健利用的影响。SDOH需求增加与自我报告的健康状况变差的可能性增加相关，尤其是心理健康。与没有SDOH需求的人相比，有1 - 2项SDOH需求（调整风险比[aRR]为1.25；95%置信区间[CI]：1.06 - 1.46）和3项或更多SDOH需求（aRR为1.45；95% CI：1.22 - 1.73）的人报告任何行为健康状况的风险更高。然而，SDOH的数量对心理健康护理服务的使用有分级但相反的影响，即使用护理的人群中就诊次数较少。有SDOH与急诊就诊可能性增加和初级保健就诊次数增加相关。本研究证明了SDOH对健康和医疗保健使用的复合影响。这突出了在考虑患者的健康和医疗保健时收集SDOH（包括SDOH需求总数）的重要性。
