Association of Social Determinants of Health and Their Cumulative Impact on Hospitalization Among a National Sample of Community-Dwelling US Adults

Abstract Importance While the association between Social Determinants of Health (SDOH) and health outcomes is well known, few studies have explored the impact of SDOH on hospitalization. Objective Examine the independent association and cumulative effect of six SDOH domains on hospitalization. Design Using cross-sectional data from the 2016–2018 National Health Interview Surveys (NHIS), we used multivariable logistical regression models controlling for sociodemographics and comorbid conditions to assess the association of each SDOH and SDOH burden (i.e., cumulative number of SDOH) with hospitalization. Setting National survey of community-dwelling individuals in the US Participants Adults ≥18 years who responded to the NHIS survey Exposure Six SDOH domains (economic instability, lack of community, educational deficits, food insecurity, social isolation, and inadequate access to medical care) Measures Hospitalization within 1 year Results Among all 55,186 respondents, most were ≤50 years old (54.2%), female (51.7%, 95% CI 51.1–52.3), non-Hispanic (83.9%, 95% CI 82.4–84.5), identified as White (77.9%, 95% CI 76.8–79.1), and had health insurance (90%, 95% CI 88.9–91.9). Hospitalized individuals (n=5506; 8.7%) were more likely to be ≥50 years old (61.2%), female (60.7%, 95% CI 58.9–62.4), non-Hispanic (87%, 95% CI 86.2–88.4), and identify as White (78.5%, 95% CI 76.7–80.3), compared to those who were not hospitalized. Hospitalized individuals described poorer overall health, reporting higher incidence of having ≥5 comorbid conditions (38.9%, 95% CI 37.1–40.1) compared to those who did not report a hospitalization (15.9%, 95% CI 15.4–16.5). Hospitalized respondents reported higher rates of economic instability (33%), lack of community (14%), educational deficits (67%), food insecurity (14%), social isolation (34%), and less access to health care (6%) compared to non-hospitalized individuals. In adjusted analysis, food insecurity (OR: 1.36, 95% CI 1.22–1.52), social isolation (OR: 1.17, 95% CI 1.08–1.26), and lower educational attainment (OR: 1.12, 95% CI 1.02–1.25) were associated with hospitalization, while a higher SDOH burden was associated with increased odds of hospitalization (3–4 SDOH [OR: 1.25, 95% CI 1.06–1.49] and ≥5 SDOH [OR: 1.72, 95% CI 1.40–2.06]) compared to those who reported no SDOH. Conclusions Among community-dwelling US adults, three SDOH domains: food insecurity, social isolation, and low educational attainment increase an individual’s risk of hospitalization. Additionally, risk of hospitalization increases as SDOH burden increases.

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Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211057847 ◽

2021 ◽

pp. 104990912110578

Author(s):

Hyunjin Noh ◽

Hee Y. Lee ◽

Lewis H. Lee ◽

Yan Luo

Keyword(s):

Health Literacy ◽

Social Determinants Of Health ◽

Social Isolation ◽

Social Determinants ◽

Hospice Care ◽

Demographic Characteristics ◽

Black Belt ◽

Determinants Of Health ◽

Black Belt Region ◽

Alabama's Black Belt

Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

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Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186684 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6684

Author(s):

Macarius M. Donneyong ◽

Teng-Jen Chang ◽

John W. Jackson ◽

Michael A. Langston ◽

Paul D. Juarez ◽

...

Keyword(s):

Food Insecurity ◽

Social Determinants Of Health ◽

Social Determinants ◽

Antihypertensive Medication ◽

Social Supports ◽

Determinants Of Health ◽

P Value ◽

County Level ◽

Medication Treatment ◽

Factors Associated

Background: Non-adherence to antihypertensive medication treatment (AHM) is a complex health behavior with determinants that extend beyond the individual patient. The structural and social determinants of health (SDH) that predispose populations to ill health and unhealthy behaviors could be potential barriers to long-term adherence to AHM. However, the role of SDH in AHM non-adherence has been understudied. Therefore, we aimed to define and identify the SDH factors associated with non-adherence to AHM and to quantify the variation in county-level non-adherence to AHM explained by these factors. Methods: Two cross-sectional datasets, the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016 cycle) and the 2016 County Health Rankings (CHR), were linked to create an analytic dataset. Contextual SDH variables were extracted from the CDC-CHR linked dataset. County-level prevalence of AHM non-adherence, based on Medicare fee-for-service beneficiaries’ claims data, was extracted from the CDC Atlas dataset. The CDC measured AHM non-adherence as the proportion of days covered (PDC) with AHM during a 365 day period for Medicare Part D beneficiaries and aggregated these measures at the county level. We applied confirmatory factor analysis (CFA) to identify the constructs of social determinants of AHM non-adherence. AHM non-adherence variation and its social determinants were measured with structural equation models. Results: Among 3000 counties in the U.S., the weighted mean prevalence of AHM non-adherence (PDC < 80%) in 2015 was 25.0%, with a standard deviation (SD) of 18.8%. AHM non-adherence was directly associated with poverty/food insecurity (β = 0.31, P-value < 0.001) and weak social supports (β = 0.27, P-value < 0.001), but inversely with healthy built environment (β = −0.10, P-value = 0.02). These three constructs explained one-third (R2 = 30.0%) of the variation in county-level AHM non-adherence. Conclusion: AHM non-adherence varies by geographical location, one-third of which is explained by contextual SDH factors including poverty/food insecurity, weak social supports and healthy built environments.

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Impact of COVID-19 Pandemic on Life-Space Mobility of Older Adults Living in Brazil: REMOBILIZE Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.643640 ◽

2021 ◽

Vol 9 ◽

Author(s):

Monica R. Perracini ◽

Juleimar Soares Coelho de Amorim ◽

Camila Astolphi Lima ◽

Alexandre da Silva ◽

Francis Trombini-Souza ◽

...

Keyword(s):

Older Adults ◽

Social Determinants Of Health ◽

Health Inequalities ◽

Social Determinants ◽

Substantial Reduction ◽

Community Dwelling ◽

Determinants Of Health ◽

Vulnerable Groups ◽

Life Space ◽

Social Restriction

Background: The COVID-19 pandemic hit Brazil in a scenario of substantial socioeconomic and health inequalities. It is unknown the immediate impact of social restriction recommendations (i.e., lockdown, stay-at-home) on the life-space mobility of older people.Objective: To investigate the immediate impact of COVID-19 pandemic on life-space mobility of community-dwelling Brazilian older adults and examine the social determinants of health associated with change in life-space mobility.Design: Baseline data from a prospective cohort study (REMOBILIZE Study).Setting: Community.Subject: A convenience snowball sample of participants aged 60 and older (n = 1,482) living in 22 states in Brazil.Methods: We conducted an online and phone survey using an adapted version of the Life-Space Assessment (LSA). Linear regression models were used to investigate social determinants of health on the change in LSA score.Results: Regardless of their gender and social determinants of health, participants showed a significant reduction in life-space mobility since COVID-19 pandemic outbreak. Life-space mobility reduction was higher among black individuals, those living alone and aged between 70 and 79. Other variables associated with change in life-space mobility, to a lesser extent, were sex, education and income.Conclusion: Social restriction measures due to pandemic caused substantial reduction in older adults' life-space mobility in Brazil. Social inequalities strongly affected vulnerable groups. Concerted actions should be put in place to overcome the deterioration in life-pace mobility amongst these groups. Failure in minimizing health inequalities amplified by the pandemic may jeopardize the desired achievements of the Decade of Healthy Aging.

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Identification of factors related to food insecurity and the implications for social determinants of health screenings

BMC Public Health ◽

10.1186/s12889-021-11465-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ashley R. Banks ◽

Bethany A. Bell ◽

David Ngendahimana ◽

Milen Embaye ◽

Darcy A. Freedman ◽

...

Keyword(s):

Food Insecurity ◽

Social Determinants Of Health ◽

Social Determinants ◽

Supplemental Nutrition Assistance Program ◽

Determinants Of Health ◽

Healthy Foods ◽

Supplemental Nutrition ◽

Assistance Program ◽

And Behaviors ◽

Nutrition Assistance

Abstract Background Food insecurity and other social determinants of health are increasingly being measured at routine health care visits. Understanding the needs and behaviors of individuals or families who screen positive for food insecurity may inform the types of resources they need. The goal of this research was to identify modifiable characteristics related to endorsement of two food insecurity screener questions to better understand the resources necessary to improve outcomes. Methods Analysis was conducted focusing on cross-sectional survey data collected in 2015–2016 from participants (N = 442) living in urban neighborhoods in Ohio with limited access to grocery stores. Food insecurity was assessed by the endorsement of at least one of two items. These were used to categorize participants into two groups: food insecure(N = 252) or food secure (N = 190). Using logistic regression, we estimated the association between several variables and the food insecure classification. Results Those that used their own car when shopping for food had lower odds of reporting food insecurity, as did those with affirmative attitudes related to the convenience of shopping for and ease of eating healthy foods. As shopping frequency increased, the odds of food insecurity increased. Food insecurity also increased with experience of a significant life event within the past 12 months. There was an 81% increase in the odds of reporting food insecurity among participants who received Supplemental Nutrition Assistance Program benefits compared to those not receiving Supplemental Nutrition Assistance Program benefits. Conclusions Along with referrals to SNAP, clinicians can further address screening-identified food insecurity through provision of transportation supports and linkages to other social services while collaborating on community initiatives to promote convenient and easy access to healthy foods. The needs and behaviors associated with screens indicating food insecurity also have implications for impacting other SDH, and thus, health outcomes.

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Creation and Validation of a Polysocial Score for Mortality Among Community-Dwelling Older Adults in the United States

Innovation in Aging ◽

10.1093/geroni/igab046.624 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 164-164

Author(s):

Yongjing Ping ◽

Chenkai Wu ◽

Michelle Odden ◽

Robert Stawski ◽

Hoda Magid

Keyword(s):

Older Adults ◽

Social Determinants Of Health ◽

Social Determinants ◽

Social Factors ◽

The United States ◽

Community Dwelling ◽

Determinants Of Health ◽

Stepwise Logistic Regression ◽

Social Environments ◽

Social Interventions

Abstract The interrelatedness between social determinants of health impedes researchers to identify important social factors for health investment. Since the older population had highly diverse social backgrounds, a new approach is needed to quantify the aggregate effect of social factors and develop person-centered social interventions. Participants ([n = 7383], 54.5% female) were aged 65 years or above who complete an additional psychosocial questionnaire in the Health and Retirement Study (HRS) at study entry in 2006 or 2008. Social determinants of health encompassing five social domains: economic stability, neighborhood and physical environment, education, community and social context, and health care system. Five-year mortality was calculated as the number of years from the interview date to the death date. We used the forward stepwise logistic regression to construct the polysocial score and multivariate logistic regressions to assess the associations between polysocial score and five-year mortality. Polysocial score (range: 7 to 59, mean±SD: 35.5±7.5) was created using 15 social determinants of health. Of the 7383 participants, 491 (30.8%), 599 (17.2%), and 166 (7.8%) deaths occurred over five years among participants with a low (0-29), intermediate (30-39), and high (40+) polysocial score, respectively. Participants with an intermediate (Odds Ratio [OR]=0.76; 95% CI, 0.65-0.89) or high (OR=0.46; 95% CI, 0.36-0.59) polysocial score had higher odds of death than those in the low category in the fully adjusted model, respectively. The polysocial approach may offer possible solutions to monitor social environments and suggestions for older adults to improve their social status for specific health outcomes.

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Number of Social Determinants of Health and Fatal and Nonfatal Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circulationaha.120.048026 ◽

2020 ◽

Author(s):

Monika M. Safford ◽

Evgeniya Reshetnyak ◽

Madeline R. Sterling ◽

Joshua S. Richman ◽

Paul M. Muntner ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Social Determinants Of Health ◽

Racial Differences ◽

Social Determinants ◽

Clinical Care ◽

Community Dwelling ◽

Determinants Of Health ◽

Incident Coronary Heart Disease ◽

Prospective Longitudinal

Background: Social determinants of health (SDH) are individually associated with incident coronary heart disease (CHD) events. Indices reflecting social deprivation have been developed for population management, but are difficult to operationalize during clinical care. We examined whether a simple count of SDH is associated with fatal incident CHD and nonfatal myocardial infarction (MI). Methods: We used data from the prospective longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, a national population-based sample of community-dwelling Black and white adults age ≥45 years recruited from 2003-7. Seven SDH from the five Healthy People 2020 domains included social context (Black race, social isolation); education (educational attainment); economic stability (annual household income); neighborhood (living in a zip code with high poverty); and healthcare (lacking health insurance, living in one of the 9 US states with the least public health infrastructure). Outcomes were expert adjudicated fatal incident CHD and nonfatal MI. Results: Of 22,152 participants free of CHD at baseline, 58.8% were women, 42.0% were Blacks, 20.6% had no SDH, 30.6% had 1, 23.0% had 2, and 25.8% had ≥3. There were 463 fatal incident CHD events and 932 nonfatal MIs over median 10.7 years [IQR 6.6-12.7]. Fewer SDH were associated with nonfatal MI than with fatal incident CHD. The age-adjusted incidence per 1000 person-years increased with the number of SDH for both fatal incident CHD (0 SDH 1.30, 1 SDH 1.44, 2 SDH 2.05, ≥3 SDH 2.86) and nonfatal MI (0 SDH 3.91, 1 SDH 4.33, ≥2 SDH 5.44). Compared to those without SDH, crude and fully adjusted hazard ratios (HR) for fatal incident CHD among those with ≥3 SDH were 3.00 (95% CI 2.17, 4.15) and 1.67 (95% CI 1.18, 2.37), respectively; and that for nonfatal MI among those with ≥2 SDH were 1.57 (95% CI 1.30, 1.90) and 1.14 (0.93, 1.41), respectively. Conclusions: A greater burden of SDH was associated with a graded increase in risk of incident CHD, with greater magnitude and independent associations for fatal incident CHD. Counting the number of SDH may be a promising approach that could be incorporated into clinical care to identify individuals at high risk of CHD.

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Awareness of Hospice Care Among Rural Residents: Findings from Social Determinants of Health Framework

Innovation in Aging ◽

10.1093/geroni/igab046.2844 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 775-775

Author(s):

Yan Luo ◽

Hyunjin Noh ◽

Lewis Lee ◽

Hee Lee

Keyword(s):

Health Literacy ◽

Social Determinants Of Health ◽

Social Isolation ◽

Social Determinants ◽

Hospice Care ◽

Demographic Characteristics ◽

Black Belt ◽

Determinants Of Health ◽

Rural Residents ◽

Black Belt Region

Abstract Although the demand for hospice care increases as our society ages, the awareness of hospice care among adults in the southern rural region of the US has not been documented. This study aims to assess the rate of hospice care awareness among rural residents living in the Black Belt Region and examine social determinants of health (SDH) associated with the awareness. A cross-sectional survey was conducted among a convenient sample living in rural Alabama (N=182, age=18-91). Participants’ awareness of hospice care, demographic characteristics (i.e., age, gender), and SDH (i.e., financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and awareness of hospice care among participants while controlling for demographic characteristics. The majority of participants had heard of hospice care (82.4%), and older participants (over 50 years old) were more likely to report having heard of hospice care (OR=7.35, p<0.05). Participants reporting worries about stable housing (OR=0.05, p<0.05) and higher social isolation were less likely to have heard of hospice care (OR=0.53, p<0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR=2.60, p<0.01). Our study is the first study assessing the status of hospice care awareness among residents living in the Black Belt Region. This study highlighted that factors including age and certain SDH (i.e., housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice care awareness.

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Developing and Pilot Testing a Population-focused Nutrition Screen Incorporating Social Determinants of Health

World Nutrition ◽

10.26596/wn.202011274-89 ◽

2020 ◽

Vol 11 (2) ◽

pp. 74-89

Author(s):

Kyle L Thompson ◽

Melissa Gutschall ◽

Amanda Bliss ◽

Grace Herman ◽

Madison Zimmerman ◽

...

Keyword(s):

United States ◽

Pilot Study ◽

Social Determinants Of Health ◽

Rural Community ◽

Social Determinants ◽

The United States ◽

Community Dwelling ◽

Low Risk ◽

Determinants Of Health ◽

Risk Status

Introduction: Given that nutrition status is directly related to a variety of health outcomes, nutrition screening is a prime focus of public health nutrition practice. Objectives: The purposes of this pilot study were to develop and pilot test a Rural Adult Nutrition Screen (RANS) that includes criteria addressing social determinants of health and to explore possible applications of the screen development methodology in other settings. Methods: Mixed-methods research including interviews and survey dissemination was conducted among a rural southern Appalachian population in the United States. Themes identified in the research were used to construct a preliminary rural adult nutrition screen (RANS-1). The RANS-1 was pilot-tested among a sample of community-dwelling rural residents (n = 83), and was revised based on participant, administrator, and nutrition practitioner comments. The revised screen, the RANS, was pilot-tested among a sample of attendees of a free community medical clinic (n = 37). Nutrition risk as determined by the RANS was compared with the Nutrition Triage Score of the Patient-Generated Subjective Global Assessment (PG-SGA), the United States Department of Agriculture 6-item Household Food Security Survey Module (USDA-6), and nutrition assessment performed by a Registered Dietitian Nutritionist who was also credentialed as a Physician Assistant (RDN, PA). Non-parametric statistical tests were used to compare the results of the PG-SGA NTS and the USDA-6 with the RANS regarding “at risk” and “low risk” status. Results: In this small pilot study, no statistically significant differences were found among either comparative instrument and the RANS in determination of “at risk” and “low risk” status. The RDN, PA’s agreement with the RANS was 100%. Conclusion: This pilot study provides some evidence that the RANS may be used to screen rural, community-dwelling adults for nutrition needs in light of social determinants of health common in rural settings. Further research and formal validation of the RANS are needed in order to establish this tool as a valid nutrition screen for use in the rural community setting. Procedures used to develop the RANS may be applicable to the development of population-specific nutrition screens in other rural and urban global populations.

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