Telzak Andrew, Levano Samantha, Haughton Jessica, Chambers Earle C, Fiori Kevin P
Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
J Clin Transl Sci. 2024 Apr 16;8(1):e78. doi: 10.1017/cts.2024.519. eCollection 2024.
Screening for health-related social needs (HRSNs) within health systems is a widely accepted recommendation, however challenging to implement. Aggregate area-level metrics of social determinants of health (SDoH) are easily accessible and have been used as proxies in the interim. However, gaps remain in our understanding of the relationships between these measurement methodologies. This study assesses the relationships between three area-level SDoH measures, Area Deprivation Index (ADI), Social Deprivation Index (SDI) and Social Vulnerability Index (SVI), and individual HRSNs among patients within one large urban health system.
Patients screened for HRSNs between 2018 and 2019 ( = 45,312) were included in the analysis. Multivariable logistic regression models assessed the association between area-level SDoH scores and individual HRSNs. Bivariate choropleth maps displayed the intersection of area-level SDoH and individual HRSNs, and the sensitivity, specificity, and positive and negative predictive values of the three area-level metrics were assessed in relation to individual HRSNs.
The SDI and SVI were significantly associated with HRSNs in areas with high SDoH scores, with strong specificity and positive predictive values (∼83% and ∼78%) but poor sensitivity and negative predictive values (∼54% and 62%). The strength of these associations and predictive values was poor in areas with low SDoH scores.
While limitations exist in utilizing area-level SDoH metrics as proxies for individual social risk, understanding where and how these data can be useful in combination is critical both for meeting the immediate needs of individuals and for strengthening the advocacy platform needed for resource allocation across communities.
在卫生系统中筛查与健康相关的社会需求（HRSNs）是一项广泛认可的建议，但实施起来具有挑战性。健康的社会决定因素（SDoH）的综合区域层面指标易于获取，并在过渡期间被用作替代指标。然而，我们对这些测量方法之间关系的理解仍存在差距。本研究评估了一个大型城市卫生系统中患者的三个区域层面SDoH指标，即区域贫困指数（ADI）、社会剥夺指数（SDI）和社会脆弱性指数（SVI）与个体HRSNs之间的关系。
纳入2018年至2019年间接受HRSNs筛查的患者（n = 45,312）进行分析。多变量逻辑回归模型评估区域层面SDoH得分与个体HRSNs之间的关联。双变量等值线图展示了区域层面SDoH与个体HRSNs的交集，并评估了这三个区域层面指标相对于个体HRSNs的敏感性、特异性以及阳性和阴性预测值。
在SDoH得分高的地区，SDI和SVI与HRSNs显著相关，具有较高的特异性和阳性预测值（约83%和约78%），但敏感性和阴性预测值较差（约54%和62%）。在SDoH得分低的地区，这些关联的强度和预测值较差。
虽然利用区域层面SDoH指标作为个体社会风险的替代指标存在局限性，但了解这些数据在何处以及如何结合使用可能有用，对于满足个体的即时需求以及加强跨社区资源分配所需的宣传平台都至关重要。
