Abstract
BackgroundNonclinical determinants of health are of increasing importance to health care delivery and health policy. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health.ObjectiveThis review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources.MethodsWe conducted a rapid review of articles and relevant agency publications published in English. Eligible studies described the effect of, the methods for, or the need for combining nonclinical data with clinical data and were published in the United States between January 2010 and April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in 2 rounds by 4 trained reviewers with interrater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported.ResultsA total of 178 articles were included in the review. The articles collectively reported on 744 different nonclinical determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, race, and ethnicity in public health surveillance. Measures related to health-related behaviors (eg, smoking, diet, tobacco, and substance abuse), the built environment (eg, transportation, sidewalks, and buildings), natural environment (eg, air quality and pollution), and health services and conditions (eg, provider of care supply, utilization, and disease prevalence) were less common, whereas measures related to public policies were rare. When combining nonclinical and clinical data, a majority of studies associated aggregate, area-level nonclinical measures with individual-level clinical data by matching geographical location.ConclusionsA variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research.
Highlights
From a health policy perspective, the nonclinical determinants of health illustrate disparities within the current US health system, many of which can only be addressed through policy interventions [6]
Among studies in which disease or condition status was the outcome, health status indicators were commonly related to body mass index or obesity, asthma, and diabetes
Measures related to socioeconomic status (SES) and material conditions were most prevalent, followed by the closely related domain of social circumstances, reflecting the existing widespread availability and use of standard demographic measures such as marital status, education, race, ethnicity in public health surveillance
Summary
Nonclinical Determinants of HealthNonclinical determinants of health, which refer collectively to the social, behavioral, and environmental factors and contexts that influence patient health outside of health care settings, are of growing importance to health care delivery and health policy. In terms of individual care, unmet needs related to nonclinical determinants of health can influence patient nonadherence to health care recommendations, limit patient-provider communication, exacerbate health conditions, and require significant time and organizational resources to address [1]. Concurrent with growing interest in better addressing patients’ nonmedical issues is the exponential growth in availability of data sources that provide insight into these nonclinical determinants of health. Objective: This review aimed to characterize the state of the existing literature on the use of nonclinical health indicators in conjunction with clinical data sources. We abstracted the measures, data sources, and level of measurement (individual or aggregate) for each nonclinical determinant of health reported. The articles collectively reported on 744 different nonclinical determinants of health measures. Conclusions: A variety of nonclinical determinants of health measures have been widely but unevenly used in conjunction with clinical data to support population health research
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