Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care.

Jennifer Tsui,Binghong Xu,Bianca Anuforo,Annie Yang,Joel C Cantor,Su Wang,Jolene Chou,Ruth Brogden

doi:10.3389/fpubh.2021.674035

Abstract

Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients.Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening.Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions.Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.

Highlights

The recognition that social determinants of health and structural barriers drive inequities in health and heath care has long been a central tenet in public health [1,2,3,4,5,6]
In some cases higher, reports of health-related social needs within our study population of primarily privately-insured, higher educated, suburban non-Hispanic Asian patients compared to statewide New Jersey data
While these reports did not significantly increase among participants recruited during the COVID-19 pandemic compared to those recruited prior to the start of the COVID-19 pandemic, we observed higher rates of interpersonal violence needs across participants in both time periods and all three survey languages when compared to similar measures in the state level data

Summary

Introduction

The recognition that social determinants of health and structural barriers drive inequities in health and heath care has long been a central tenet in public health [1,2,3,4,5,6]. There is recent focus to address social determinants of health within health care settings [7,8,9,10,11,12,13,14,15,16,17] as a way to reduce higher rates of chronic disease and poorer outcomes among vulnerable patients [18,19,20]. Few clinicbased HRSN studies to date, have focused on measuring HRSN in languages other than English or Spanish or in diverse immigrant populations, including Asian Americans (AA), where cultural factors and immigration experiences can pose additional barriers to accessing care and routine preventive services [33]. AA patients as a group are often masked by small or aggregated numbers and a lack of linguistically appropriate measurement tools within larger health system settings [34,35,36]

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