Prevalence of Emergency Department Social Risk and Social Needs

Abstract

Introduction: Social risks, or adverse social conditions associated with poor health, are prevalent in emergency department (ED) patients, but little is known about how the prevalence of social risk compares to a patient's reported social need, which incorporates patient preference for intervention. The goal of this study was to describe the relationship between social risk and social need, and identify factors associated with differential responses to social risk and social need questions. Methods: We conducted a cross-sectional study with 48 hours of time-shift sampling in a large urban ED. Consenting patients completed a demographic questionnaire and assessments of social risk and social need. We applied descriptive statistics to the prevalence of social risk and social need, and multivariable logistic regression to assess factors associated with social risk, social need, or both. Results: Of the 269 participants, 100 (37%) reported social risk, 83 (31%) reported social need, and 169 (63%) reported neither social risk nor social need. Although social risk and social need were significantly associated (p < 0.01), they incompletely overlapped. Over 50% in each category screened positive in more than one domain (eg, housing instability, food insecurity). In multivariable models, those with higher education (adjusted odds ratio [aOR] 0.44 [95% confidence interval {CI}, 0.24-0.80]) and private insurance (aOR 0.50 [95% CI, 0.29-0.88]) were less likely to report social risk compared to those with lower education and state/public insurance, respectively. Spanish-speakers (aOR 4.07 [95% CI, 1.17-14.10]) and non-Hispanic Black patients (aOR 5.00 [95% CI, 1.91-13.12]) were more likely to report social need, while those with private insurance were less likely to report social need (private vs state/public: aOR 0.13 [95% CI, 0.07-0.26]). Conclusion: Approximately one-third of patients in a large, urban ED screened positive for at least one social risk or social need, with over half in each category reporting risk/need across multiple domains. Different demographic variables were associated with social risk vs social need, suggesting that individuals with social risks differ from those with social needs, and that screening programs should consider including both assessments. [

A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

“…4,5 The emergency department (ED) is an ideal setting for examining the impact of SDoH on health outcomes and health service utilization. [6][7][8] Because ED patients are vastly diverse with regard to socioeconomic demographics and are likely to have higher rates of health-related social needs, EDs are particularly well-positioned to study and address social underpinnings of health inequities. Research has shown that reasons for using the ED as a primary access point for health care, even when insured, include challenges related to low socioeconomic status (eg, transportation, work release, and childcare for multiple visits), greater ability of EDs to meet patient time constraints (eg, single visit or "one-stop shop" service, 365/24/7 availability), and barriers to primary care (eg, difficulty keeping appointments, problems with after-hours coverage, scarcity of urgent appointments).…”

Interrelationships of Economic Stressors, Mental Health Problems, Substance Use, and Intimate Partner Violence among Hispanic Emergency Department Patients: The Role of Language-Based Acculturation

“…Urban ED patients comprise an at-risk, socially disadvantaged population, with elevated rates of unemployment, substance use, and mental health problems [33,34]. A recent ED-based study found that 37% of participants screened positively for social risks, defined as adverse social conditions associated with poor health, such as housing instability and food insecurity [35]. Additionally, compared to adults in the general household population, ED patients have an elevated prevalence of IPV.…”

Structural competency in emergency medical education: A scoping review and operational framework

“…[1][2][3][4] Recent scholarship in emergency medicine (EM) has turned to studying the upstream drivers of disenfranchised patients' reliance on ED services and the structural barriers to their overall health and well-being. [5][6][7][8] Similarly, EM educators have called for training structurally competent physicians-ones engaged in lifelong learning and self-reflection to recognize and respond to societal forces and structures that affect signs and symptoms of individual illness. 9 "Structural competency," first proposed by Metzl and Hansen, is defined as the trained ability for health professionals to recognize and respond to signs and symptoms of individual illness as the downstream effects of broad historical, social, political, and economic structures.…”