Relative Burden of Social Determinants of Health on Diverse Populations of Health Resources and Services Administration Health Centers.
Social determinants of health (SDOH) disproportionately affect racial/ethnic groups. However, little is known about how the cumulative burden of SDOH disadvantage on health status varies by race/ethnicity.
To examine the relative burden of SDOH disadvantage by race/ethnicity on two measures of health status of Health Resources and Services Administration-funded health center patients.
Cross-sectional study design.
We used the 2022 Health Center Patient Survey to identify a sample of adult health center patients (n = 3912).
We developed an overall composite score and five specific sub-scores for each SDOH domain-health risk, economic, social, access, and built environment-to measure cumulative burden of SDOH disadvantage. We used self-reported fair or poor health status and moderate or high psychological distress to measure general and mental health, respectively. We used logistic regression models to examine the independent association of each SDOH domain and their relative burden on health status measures by racial/ethnic groups.
Across all groups, higher health risk (OR = 1.57), economic (1.29), social (1.30), access (1.56), and built environment (1.15) disadvantage; and higher health risk (1.14), economic (1.44), and access (1.77) disadvantage were associated with fair or poor general health and greater psychological distress, respectively. However, some relationships differed by race/ethnicity. For example, higher health risk and access disadvantage increased the likelihood of poor general health among Non-Hispanic Black/African American and Hispanic/Latino patients. But economic disadvantage was significant for the former and social disadvantage was significant for the latter.
Our study highlighted the importance of accounting for differential burden of SDOH domains on racial/ethnic groups. This requires comprehensive measurement of SDOH and its meaningful use to inform and improve care for diverse health center patients. Access disadvantage across all racial/ethnic groups emphasized the importance of culturally appropriate care coordination to improve patient health.
To examine the relative burden of SDOH disadvantage by race/ethnicity on two measures of health status of Health Resources and Services Administration-funded health center patients.
Cross-sectional study design.
We used the 2022 Health Center Patient Survey to identify a sample of adult health center patients (n = 3912).
We developed an overall composite score and five specific sub-scores for each SDOH domain-health risk, economic, social, access, and built environment-to measure cumulative burden of SDOH disadvantage. We used self-reported fair or poor health status and moderate or high psychological distress to measure general and mental health, respectively. We used logistic regression models to examine the independent association of each SDOH domain and their relative burden on health status measures by racial/ethnic groups.
Across all groups, higher health risk (OR = 1.57), economic (1.29), social (1.30), access (1.56), and built environment (1.15) disadvantage; and higher health risk (1.14), economic (1.44), and access (1.77) disadvantage were associated with fair or poor general health and greater psychological distress, respectively. However, some relationships differed by race/ethnicity. For example, higher health risk and access disadvantage increased the likelihood of poor general health among Non-Hispanic Black/African American and Hispanic/Latino patients. But economic disadvantage was significant for the former and social disadvantage was significant for the latter.
Our study highlighted the importance of accounting for differential burden of SDOH domains on racial/ethnic groups. This requires comprehensive measurement of SDOH and its meaningful use to inform and improve care for diverse health center patients. Access disadvantage across all racial/ethnic groups emphasized the importance of culturally appropriate care coordination to improve patient health.
Authors
Pourat Pourat, Lu Lu, Chen Chen, Haile Haile, Benjamin Benjamin, Picillo Picillo, Hoang Hoang
View on Pubmed