Significance of Multiple Adverse Social Determinants of Health on the Diagnosis, Control, and Management of Diabetes

Kim, Young Ho; Abrahams, Sara; Marrast, Lyndonna; Martinez, Johanna; Hanchate, Amresh; Conigliaro, Joseph

doi:10.1007/s11606-020-05860-9

Cited by 8 publications

(6 citation statements)

References 5 publications

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“…These highlight the importance of robust food, housing, economic, health, and social policies to dismantle structural factors underlying health inequities. 37 At the patient level, prior research 36 , 38 , 39 , 40 shows that the cumulative burden of unmet social needs can adversely affect health care utilization, health management behaviors, disease management, and overall mortality. Compounded with food insecurity—which already is an independent risk factor for poor diet and diet-sensitive chronic disease—these findings reinforce the need for health care–based interventions to support multiple social needs more holistically within the same individual and household.…”

Section: Discussionmentioning

confidence: 99%

Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan

Leung,

Patel,

Miller

et al. 2024

JAMA Netw Open

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ImportanceHealth care systems are increasingly adopting methods to screen for and integrate food insecurity and other social risk factors into electronic health records. However, there remain knowledge gaps regarding the cumulative burden of food insecurity in large clinical settings, which patients are most at risk, and the extent to which patients are interested in social assistance through their health care system.ObjectiveTo evaluate the 5-year prevalence and associated risk factors of food insecurity among adult primary care patients, and to examine factors associated with patients’ interest in social assistance among those with food insecurity.Design, Setting, and ParticipantsThis cross-sectional analysis of a retrospective cohort study took place at a tertiary care academic medical center (encompassing 20 primary care clinics) in Michigan. Participants included adult patients who completed screening for social risk factors between August 1, 2017, and August 1, 2022. Data analysis was performed from November 2022 to June 2023.ExposureFood insecurity was assessed using the Hunger Vital Sign.Main Outcomes and MeasuresThe primary outcome was patients’ interest in social assistance, and associated factors were examined using multivariate logistic regression models, adjusting for patients’ demographic and health characteristics.ResultsOver the 5-year period, 106 087 adult primary care patients (mean [SD] age, 52.9 [17.9] years; 61 343 women [57.8%]) completed the standardized social risk factors questionnaire and were included in the analysis. The overall prevalence of food insecurity was 4.2% (4498 patients), with monthly trends ranging from 1.5% (70 positive screens) in August 2018 to 5.0% (193 positive screens) in June 2022. Food insecurity was significantly higher among patients who were younger, female, non-Hispanic Black or Hispanic, unmarried or unpartnered, and with public health insurance. Food insecurity was significantly associated with a higher cumulative burden of social needs, including social isolation, medical care insecurity, medication nonadherence, housing instability, and lack of transportation. Only 20.6% of patients with food insecurity (927 patients) expressed interest in social assistance. Factors associated with interest in social assistance including being non-Hispanic Black, unmarried or unpartnered, a current smoker, and having a higher burden of other social needs.Conclusions and RelevanceIn this retrospective cohort study, the overall prevalence of food insecurity was 4.2%, of whom approximately 1 in 5 patients with food insecurity expressed interest in assistance. This study highlights ongoing challenges in ensuring all patients complete routine social determinants of health screening and gaps in patients’ interest in assistance for food insecurity and other social needs through their health care system.

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Section: Discussionmentioning

confidence: 99%

Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan

Leung,

Patel,

Miller

et al. 2024

JAMA Netw Open

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“…Previous work has highlighted the gradient or "doseresponse" of multiple adverse SDOH on clinical outcomes (e.g., control and management of diabetes). 10,15 Additionally, there has been work exploring the association of SDOH on hospitalization. 16,17 Yet, to our knowledge, little work has been done to capture the cumulative effect SDOH have on hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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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“…People with T2DM have considerably higher rates in census tracts with substantially lower household earnings, fewer high school graduates, more single parents, and overcrowding. The probability of developing T2DM in pre-diabetic grown-ups was increased in census tracts where residents had lower levels of schooling, lower yearly earnings, and a more elevated proportion of households receiving Supplemental Nutrition Assistance Program (SNAP) benefits [ 5 ].…”

Section: Reviewmentioning

confidence: 99%

Complications in Diabetes Mellitus: Social Determinants and Trends

Cuddapah¹,

Chennakesavulu²,

Pentapurthy³

et al. 2022

Cureus

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Conditions that impact an individual's health are referred to as social determinants of health. Through a retrospective study (January 2017-February 2022) and statistical analysis, researchers looked at the relationship between social demands and type 2 diabetes mellitus (T2DM) diagnosis. All social demands, with the exception of childcare, were more typically documented in patients with T2DM. Prescription expense, conveyance, and health literacy were the domains with the greatest relationships. These results might help health systems and social service providers develop collaborations to help in certain areas.

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Significance of Multiple Adverse Social Determinants of Health on the Diagnosis, Control, and Management of Diabetes

Cited by 8 publications

References 5 publications

Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan

Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan

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

Complications in Diabetes Mellitus: Social Determinants and Trends

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