Abstract 34: Social Risks, Glycemic Control and Elevated Blood Pressure Among Patients With Diabetes in the Ascension Health System

Abstract

Background: Calls to address social risks have stimulated interest in integrating screening measures into the electronic medical record (EMR) - particularly, self-reported individual level social risks - to improve care for chronic diseases like diabetes (DM). Objective: Examine associations between individual-level social risks and glycemic control and elevated blood pressure (BP) among patients with DM in the Ascension Health System. Methods: A 10-item EMR-embedded survey [access to care, resources, transportation, employment] was collected in Ascension primary care clinics in 12 U.S. states. Neighborhood-level risk was characterized with the CDC Social Vulnerability index (SVI) by census tract of patients’ residences. Associations between social risk (individual/composite) and uncontrolled DM (HbA1c >9%) and elevated BP (>120/80) adjusting for age, sex, race/ethnicity, SVI, region, and chronic conditions were examined. Results: Among 75,848 patients with DM and social risk data available [median age 62, 53% female, 22% Black, 7.5% Hispanic]. 20% had poor glycemic control; 27% had elevated BP; 20% lived in a high SVI census tract. Patients identifying any social risk were more likely to have poor glycemic or elevated BP. Patients with the highest social risk scores had higher odds of uncontrolled glycemia (OR 1.72, 95% CI 1.60-1.85) and elevated BP (OR 1.18, 95% CI 1.10-1.26). Conclusion: Examination of a large sample of primary care patients in a large multi-region health system determined that individual-level social risks were correlated with glycemic and BP control. These data highlight the need to simultaneously address social risks and medical conditions to impact population health.