Demographic Correlates of Veterans’ Adverse Social Determinants of Health

Abstract

Identifying patient populations most affected by adverse social determinants of health can direct epidemiologic investigation, guide development of tailored interventions, and improve clinical care and outcomes. This study explores how demographic characteristics are associated with specific types-and cumulative burden-of adverse social determinants of health among Veterans seeking Veterans Health Administration health care. Data included electronic health records for 293,872 patients of Veterans Health Administration facilities in one region of the country between October 1, 2015 and September 30, 2016. A series of multiple logistic regressions conducted between August and December 2019 examined how demographic variables are associated with 7 adverse social determinants of health. A negative binomial regression examined the association between demographic characteristics and cumulative burden of social determinants of health. Demographic characteristics were associated with increased odds of each type of adverse social determinant of health: minority race, unmarried status, and Veterans' service connected disability status. Conversely, living in a rural area and being aged >40 years were associated with decreased odds of most of the adverse social determinants of health studied here. Hispanic ethnicity and female sex were inconsistently associated with increased odds of some adverse social determinants of health and decreased odds of others. These results are mirrored in the analysis of predictors of cumulative burden of adverse social determinants of health. There is increasing and ongoing interest in ways to identify and respond to patients' experiences of or exposures to adverse social determinants of health. Demographic characteristics may signal the need to assess for adverse social determinants of health. Analyses exploring latent factors among these social determinants (e.g., poverty) may inform strategies to identify patients experiencing adverse social determinants of health and provide responsive interventions.