Brown Meagan C, Cushing-Haugen Kara, Wellman Robert, Dorsey Caitlin N, Norris Consuelo Ms, Adams John L, Steiner John F, Shah Anand R, Lewis Cara C
Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
University of Washington School of Public Health, Seattle, Washington.
AJPM Focus. 2024 Oct 9;4(1):100283. doi: 10.1016/j.focus.2024.100283. eCollection 2025 Feb.
Social health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals' social risks such as food, housing, transportation, and financial insecurity and their interest in receiving assistance from the healthcare system (social needs) can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions.
The authors conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020. Study inclusion was based on membership, age, address, and absence of dementia. Modified Poisson regression models estimated respondents' social risks and needs overall and within domain (food, housing, finances, or transportation) and by intersectional strata on the basis of a combination of age, income, gender, and race and ethnicity.
Of 10,274 participants who completed the survey, 52% reported any social risk, and 32% had any social need. Financial strain was the most prevalent risk (44%), followed by food insecurity (31%), housing instability (17%), and transportation (7%). These intersectional analyses generated 74 intersectional groups. Across the intersectional groups, higher-income (>$50,000 per year) or older-age (>60 years) adults consistently had lower risk and need. However, this pattern varied by race and ethnicity. In particular, older and lower-income, Pacific Islander, African-American/Black, and multiracial adults had the highest estimates of social risk and need.
Higher risk and need among particular intersectional groups suggest the importance of tailored interventions for social needs. The high aggregate prevalence of social risks and needs suggests that system and policy changes must compliment universal and population-based social health screening and assistance interventions in healthcare organizations.
社会健康日益成为医疗保健系统关注的焦点。对个人社会风险（如食品、住房、交通和经济不安全）及其接受医疗保健系统援助的意愿（社会需求）进行代表性和交叉性分析，可为医疗保健组织提供更细致入微的评估，从而带来更有效的干预措施。
作者于2019年12月至2020年9月对凯撒医疗集团43936名成员的代表性样本进行了横断面调查。纳入研究的对象基于成员资格、年龄、住址以及无痴呆症。修正泊松回归模型根据年龄、收入、性别、种族和民族的组合，总体以及在各个领域（食品、住房、财务或交通）内并按交叉分层估计了受访者的社会风险和需求。
在完成调查的10274名参与者中，52%报告有任何社会风险，32%有任何社会需求。经济压力是最普遍的风险（44%），其次是粮食不安全（31%）、住房不稳定（17%）和交通（7%）。这些交叉分析产生了74个交叉群体。在各个交叉群体中，高收入（每年超过5万美元）或年龄较大（>60岁）的成年人风险和需求始终较低。然而，这种模式因种族和民族而异。特别是，年龄较大且低收入的太平洋岛民、非裔美国人/黑人以及多种族成年人的社会风险和需求估计最高。
特定交叉群体中较高的风险和需求表明针对社会需求进行量身定制干预措施的重要性。社会风险和需求的总体患病率较高，这表明系统和政策变革必须补充医疗保健组织中普遍的、基于人群的社会健康筛查和援助干预措施。
