Social Determinants Of Health Research Articles

Incorporating Social Needs Screening in Simulation for Family Nurse Practitioner Students.

A pilot simulation was implemented at a private university school of nursing to provide an opportunity for family nurse practitioner (FNP) students to apply their knowledge of assessing and addressing social determinants of health (SDOH). The Social Needs Screening Tool (SNST), developed by the American Academy of Family Physicians, and SDOH content were incorporated into a tele-health simulation-based learning experience. Using Zoom [Zoom Video Communications, Inc.], students encountered a standardized patient who sought care for shoulder pain and shared concerns about transportation and finances. Thirty-nine FNP students individually completed the simulation. Evaluation was conducted via an adapted Simulation Effectiveness Tool-Modified and written feedback to assess confidence and skills. Eighty-nine percent of students reported they felt more comfortable using the SNST following the simulation. Incorporating SDOH content and the SNST within simulation-based learning is an effective learning activity to enhance FNP student confidence and skills in assessing and addressing SDOH. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Sustainability Strategies for Multisector Community Partnerships Addressing Social Determinants of Health

Multisector community partnerships (MCPs) are a key element of the public health approach to addressing social determinants of health (SDOH). The Improving SDOH—Getting Further Faster (GFF) retrospective evaluation of MCP-driven SDOH interventions was designed to generate practice-based evidence that can help guide partnerships’ efforts to improve chronic disease outcomes and advance health equity by addressing SDOH. This article shares Year 2 GFF findings related to sustainability strategies for partnerships focused on SDOH and their interventions. GFF partnerships’ reported sustainability strategies, including establishing shared goals and increasing partners’ capacity for SDOH work through training, align well with the rich coalition building evidence base. Findings also indicate some evolution of sustainability strategies, such as adopting team-based, decentralized leadership models to help guard against partner or staff turnover. Organizations looking to form, fund, or provide technical assistance to MCPs that address SDOH can use the practice-based insights shared in this research brief to plan ahead for sustainability.

Social determinants of health and diabetes in pregnancy.

Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. SDOH are systemic factors that may explain, perpetuate, and exacerbate disparities in health outcomes for different populations, and can be measured at both an individual- and neighborhood- or community-level (iSDOH, nSDOH). In pregnancy, increasing evidence shows that adverse iSDOH and/or nSDOH are associated with a greater likelihood that diabetes develops, and that when it develops, there is worse glycemic control and a greater frequency of adverse pregnancy outcomes. Future research should not only continue to examine the relationships between SDOH and adverse pregnancy outcomes with diabetes, but should determine whether multi-level interventions that seek to mitigate adverse SDOH result in equitable maternal care and improved patient health outcomes for pregnant individuals living with diabetes.

Parity and post-reproductive mortality among U.S. Black and White women: Evidence from the health and retirement study

Population health research finds women’s mortality risk associated with childlessness, low parity (one child), and high parity (6+ children) in a U-shaped pattern, although U.S. studies are inconsistent overall and by race/ethnicity. Parity, however, is contingent on women’s biophysiological likelihood of (in)fecundity as well as voluntary control practices that limit fertility. No studies have empirically examined infecundity differentials among women and their potential contribution to the parity–post-reproductive mortality relationship or the race/ethnic-related mortality gap. We examine 7,322 non-Hispanic Black and White women, born 1920–1941, in the Health and Retirement Study, using zero-inflation methods to estimate infecundity risk and parity by race/ethnicity. We estimate proportional hazards models [t0 1992/1998, t1 2018] to examine associations of infecundity risk, parity, early-life-course health and social statuses, and post-reproductive statuses with all-cause mortality. We find Black women’s infecundity probability to be twice that of White women and their expected parity 40% higher. Infecundity risk increases mortality risk for all women, but parity–post-reproductive mortality associations differ by race/ethnicity. White women with one and 5+ children (U-shaped curve) have increased mortality risk, adjusting for infecundity risk and early-life factors; further adjustment for post-reproductive health and social status attenuates all parity-related mortality risk. Black women’s parity–post-reproductive mortality associations are not statistically significant. Black women’s post-reproductive mortality risk is anchored in earlier-life conditions that elevate infecundity risk. Results suggest a need to focus upstream to better elucidate race/ethnic-related social determinants of reproductive health, infecundity, parity, and mortality.

Social Determinants of Health and Insurance Claim Denials for Preventive Care.

The Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket cost-sharing for recommended preventive care for most privately insured patients. However, patients seeking preventive care continue to face cost-sharing and administrative hurdles, including claim denials, which may exacerbate inequitable access to care. To determine whether patient demographics and social determinants of health are associated with denials of insurance claims for preventive care. This cohort study of patients insured through their employers or the ACA Marketplaces used claims and remittance data from Symphony Health Solutions' Integrated DataVerse from 2017 to 2020; analysis was completed from January to July 2024. Seeking preventive care. The primary outcome was the frequency of insurer denials for preventive services across 5 categories: specific benefit denials, billing errors, coverage lapses, inadequate coverage, and other. Subgroup analysis was performed across patient household income, education, and race and ethnicity. Secondary outcomes included charges for denied claims, approximating patients' remaining financial responsibility for care. A total of 1 535 181 patients received 4 218 512 preventive services in 2 507 943 unique visits (mean [SD] age at visits, 54.02 [13.19] years; 1 804 637 visits for female patients [71.96%]); 585 299 patients (23.30%) had an annual household income $100 000 or higher, and 824 540 patients had some college education (32.88%). A total of 20 658 individuals (0.82%) were Asian, 139 950 (5.58%) were Hispanic, 219 646 (8.76%) were non-Hispanic Black, 1 372 223 (54.72%) were non-Hispanic White, and 25 412 (1.0%1) were other races and ethnicities not included in the other 4 groups. Of preventive claims, 1.34% (95% CI, 1.32%-1.36%) were denied, consisting mainly of specific benefit denials (0.67%; 95% CI, 0.66%-0.68%) and billing errors (0.51%; 95% CI, 0.50%-0.52%). The lowest-income patients had 43.0% higher odds of experiencing a denial than the highest-income patients (odds ratio, 1.43; 95% CI, 1.37-1.50; P < .001). The least educated enrollees had a denial rate of 1.79% (95% CI, 1.76%-1.82%) compared with 1.14% (95% CI, 1.12%-1.16%) for enrollees with college degrees. Denial rates for Asian (2.72%; 95% CI, 2.55%-2.90%), Hispanic (2.44%; 95% CI, 2.38%-2.50%), and non-Hispanic Black (2.04%; 95% CI, 1.99%-2.08%) patients were significantly higher than those for non-Hispanic White patients (1.13%; 95% CI, 1.12%-1.15%). In this cohort study of 1 535 181 patients seeking preventive care, denials of insurance claims for preventive care were disproportionately more common among at-risk patient populations. This administrative burden potentially perpetuates inequitable access to high-value health care.

Associations of County-Level Social Determinants of Health with COVID-19 Related Hospitalization Among People with HIV: A Retrospective Analysis of the U.S. National COVID Cohort Collaborative (N3C).

Individually, the COVID-19 and HIV pandemics have differentially impacted minoritized groups due to the role of social determinants of health (SDoH) in the U.S. Little is known how the collision of these two pandemics may have exacerbated adverse health outcomes. We evaluated county-level SDoH and associations with hospitalization after a COVID-19 diagnosis among people with (PWH) and without HIV (PWOH) by racial/ethnic groups. We used the U.S. National COVID Cohort Collaborative (January 2020-November 2023), a nationally-sampled electronic health record repository, to identify adults who were diagnosed with COVID-19 with HIV (n = 22,491) and without HIV (n = 2,220,660). We aggregated SDoH measures at the county-level and categorized racial/ethnic groups as Non-Hispanic (NH) White, NH-Black, Hispanic/Latinx, NH-Asian and Pacific Islander (AAPI), and NH-American Indian or Alaskan Native (AIAN). To estimate associations of county-level SDoH with hospitalization after a COVID-19 diagnosis, we used multilevel, multivariable logistic regressions, calculating adjusted relative risks (aRR) with 95% confidence intervals (95% CI). COVID-19 related hospitalization occurred among 11% of PWH and 7% of PWOH, with the highest proportion among NH-Black PWH (15%). In evaluating county-level SDoH among PWH, we found higher average household size was associated with lower risk of COVID-19 related hospitalization across racial/ethnic groups. Higher mean commute time (aRR: 1.76; 95% CI 1.10-2.62) and higher proportion of adults without health insurance (aRR: 1.40; 95% CI 1.04-1.84) was associated with a higher risk of COVID-19 hospitalization among NH-Black PWH, however, NH-Black PWOH did not demonstrate these associations. Differences by race and ethnicity exist in associations of adverse county-level SDoH with COVID-19 outcomes among people with and without HIV in the U.S.

Prospective associations between early childhood mental health concerns and formal diagnosis of neurodevelopmental disorders in adolescence

IntroductionUnderstanding associations between psychosocial development in early childhood and formal diagnosis of neurodevelopmental disorders (NDDs) in adolescence is critical for early identification and for tailoring interventions and support. This study investigated whether the Strengths and Difficulties Questionnaire (SDQ) scores in early childhood (4-5 years) predict mental health (MH) problems as evidenced by SDQ scores and formal diagnosis of NDDs in adolescence (16-17 years).MethodsThis study analysed data from a sample of 4968 children and adolescents using data from the Longitudinal Study of Australian Children. We used hierarchical regression models to determine the association between SDQ subscales and total scores at ages 4-5 years (primary exposure) and total SDQ scores and NDD diagnoses at ages 16-17 years (outcomes) whilst controlling for sociodemographic risk factors.ResultsEach unit increase in SDQ score at age 4-5 led to a rise in SDQ scores at age 16-17. Autism and ADHD diagnoses, female gender, lower maternal education, and financial hardship were associated with higher SDQ scores at age 16-17. Furthermore, parent reported SDQ at age 4-5 was linked to higher likelihoods of formal diagnoses of ADHD, autism, and ADHD/autism at age 16-17. Additionally, social determinants of health such as female gender, culturally and linguistically diverse (CALD) backgrounds, and financial hardship were associated with increased odds of ADHD, autism, and ADHD/autism diagnoses at age 16-17.ConclusionOur findings highlight the opportunity for early identification of transdiagnostic developmental and MH issues in the preschool period. Findings also emphasise the critical role of social determinants of health in the longitudinal trajectory of MH and NDDs and highlight the need for implementing early supports for improving peer relations and behavioural support strategies. If coupled with wrap around social care, early support strategies can enhance MH and wellbeing in adolescence and beyond.

Baltimore community resident and collaborator perspectives on the influence of guaranteed income on health: a formative qualitative study

BackgroundGiven increased interest and investment in guaranteed income initiatives across North America, it is critical to understand the impact of guaranteed income on health, an understudied outcome. As part of Baltimore, Maryland’s guaranteed income pilot, we conducted formative research to understand the influence of increased income on health and develop concrete recommendations for implementation and evaluation of the pilot.MethodsWe conducted semi-structured in-depth interviews with Baltimore community residents (n = 8) and community collaborators (n = 8), probing on familiarity with guaranteed income; effect of guaranteed income on overall health and specific health outcomes (e.g., mental health, nutrition); and recommendations for program structure (e.g., eligibility, target population). Data were analyzed thematically using a framework analysis approach.ResultsRespondents agreed that guaranteed income could have beneficial effects on health though some were unsure of specific mechanisms. Respondents emphasized pathways through which guaranteed income could improve health: (1) reduced financial-related stress; (2) improved nutrition through purchase of healthier foods; (3) improved family well-being including child health and parent-child relationships; (4) increased utilization of health services; (5) improved community health through increased community cohesion and decreased violence. Respondents described decreased feelings of time scarcity as a social determinant of health. Most respondents reported that Baltimore’s guaranteed income program should prioritize young, low-income families with $1,000/month or more for at least one year.ConclusionsThis formative research on the potential health impacts of guaranteed income in Baltimore highlights important health outcomes and pathways, such as social cohesion and decreased feelings of time scarcity, to prioritize for evaluation.

Access to land and nature as health determinants: a qualitative analysis exploring meaningful human-nature relationships among Indigenous youth in central Canada

BackgroundHuman relationships with and connections to nature and the “land” are a commonly accepted Social Determinant of Health. Greater knowledge about these relationships can inform public health policies and interventions focused on health equity among Indigenous populations. Two research questions were explored: (1) what are the experiences of meaningful human-nature relationships among Indigenous youth within central Canada; and (2) how do these relationships function as a determinant of health and wellness within their lives.MethodsDrawing from three community-based participatory research (CBPR) projects within two urban centers in Saskatchewan and Manitoba, the integrated qualitative findings presented here involved 92 interviews with 52 Indigenous youth that occurred over a period of nine years (2014–2023). Informed by “two-eyed seeing,” this analysis combined Indigenous Methodologies and a Constructivist Grounded Theory approach.ResultsOur integrative analysis revealed three cross-cutting themes about meaningful human-nature relationships: (1) promoting cultural belonging and positive identity; (2) connecting to community and family; and (3) supporting spiritual health and relationships. The experiences of young people also emphasized barriers to land and nature access within their local environments.DiscussionPolicies, practices, and interventions aimed at strengthening urban Indigenous young peoples’ relationships to and connections with nature and the land can have a positive impact on their health and wellness. Public Health systems and healthcare providers can learn about leveraging the health benefits of human-nature relationships at individual and community levels, and this is particularly vital for those working to advance health equity among Indigenous populations.

Adverse Childhood Experiences, Protective Factors, and Childhood Obesity: Comparing the Effectiveness of Three Resilience Frameworks

Abstract While rates of childhood obesity continue to rise in the United States, multiple studies have linked childhood obesity to adverse childhood experiences (ACEs). ACEs researchers have begun to develop frameworks that identify protective factors that build resilience against ACEs. However, these frameworks have a limited evidence base. Utilizing data from the 2018–2020 National Survey of Children’s Health, this study compared the effectiveness of the National Scientific Council on the Developing Child (NSCDC), Health Outcomes from Positive Experiences (HOPE), and cumulative positive childhood experiences (PCEs) frameworks in mitigating the impact of ACEs on childhood obesity. Based on hierarchical logistic regression conducted on data from 46,672 children between the ages of 10 and 17 years old, this study found that both the NSCDC and HOPE frameworks were associated with childhood obesity, with each framework explaining a similar amount of variance in childhood obesity across analyses. The cumulative PCEs framework did not strengthen the association between either framework and childhood obesity. Across analyses, strong self-regulation, mastery/after-school activities, and living in a supportive neighborhood had the strongest association with childhood obesity. The findings suggest that the most salient protective factors may be those most closely associated with the direct causes of childhood obesity, with the need to identify factors across ecological levels. Future research is needed to validate these frameworks further and explore these frameworks with other outcomes. The findings have important implications for future ACEs research and ACEs interventions. Public Relevance By understanding which resilience frameworks and protective factors have the strongest relationship with childhood obesity among children who experienced ACEs, interventions can potentially be developed using these findings to mitigate the harmful impact of ACEs on childhood obesity. Key Findings This study found that the National Scientific Council on the Developing Child (NSCDC) and Health Outcomes from Positive Experiences (HOPE) frameworks were associated with childhood obesity after controlling for adverse childhood experiences (ACEs) in a sample of children between the ages of 10 and 17 years old. The strongest protective factors against childhood obesity were strong self-regulation, mastery/after-school activities, and living in a supportive neighborhood. Given the relationship between these protective factors along with several covariates in the study with childhood obesity, future ACEs interventions should potentially target these protective factors and other social determinants of health to reduce the negative impact of ACEs on childhood obesity.

A data science-based analysis of socioeconomic determinants impacting pediatric diagnostic radiology utilization during the COVID-19 pandemic.

Research on healthcare disparities in pediatric radiology is limited, leading to the persistence of missed care opportunities (MCO). We hypothesize that the COVID-19 pandemic exacerbated existing health disparities in access to pediatric radiology services. Evaluate the social determinants of health and sociodemographic factors related to pediatric radiology MCO before, during, and after the COVID-19 pandemic. The study examined all outpatient pediatric radiology exams at a pediatric medical center and its affiliate centers from 03/08/19 to 06/07/21 to identify missed care opportunities. Logistic regression with the least absolute shrinkage and selection operator (LASSO) method and classification and regression tree (CART) analysis were used to explore factors and visualize relationships between social determinants and missed care opportunities. A total of 62,009 orders were analyzed: 30,567 pre-pandemic, 3,205 pandemic, and 28,237 initial recovery phase. Median age was 11.34years (IQR 5.24-15.02), with 50.8% females (31,513/62,009). MCO increased during the pandemic (1,075/3,205; 33.5%) compared to pre-pandemic (5,235/30,567; 17.1%) and initial recovery phase (4,664/28,237; 16.5%). The CART analysis identified changing predictors of missed care opportunities across different periods. Pre-pandemic, these were driven by exam-specific factors and patient age. During the pandemic, social determinants like income, distance, and ethnicity became key. In the initial recovery phase, the focus returned to exam-specific factors and age, but ethnicity continued to influence missed care, particularly in neurological exams for Hispanic patients. Logistic regression revealed similar results: during the pandemic, increased distance from the examination site (OR 1.1), residing outside the state (OR 1.57), Hispanic (OR 1.45), lower household income ($25,000-50,000 (OR 3.660) and $50,000-75,000 (OR 1.866)), orders for infants (OR 1.43), and fluoroscopy (OR 2.3) had higher odds. In the initial recovery phase, factors such as living outside the state (OR 1.19), orders for children (OR 0.79), and being Hispanic (OR 1.15) correlate with higher odds of MCO. The application of basic data science techniques is a valuable tool in uncovering complex relationships between sociodemographic factors and disparities in pediatric radiology, offering crucial insights into addressing inequalities in care.

Chaplains’ reports of integration in community health initiatives: a qualitative study

Health care and religious organizations have a long history with one another. Chaplains’ investments in the health and wellbeing of their local communities have extended beyond the hospital walls for longer than many chaplains may recognize. However, the published evidence suggests these efforts have been limited. Given the history of health care evolution in the United States, the small evidence of cases highlighting chaplains’ leadership within community health initiatives, and the pressure for health systems to address the social determinants of health, we sought to explore chaplains’ integration in community health and wellness initiatives. This paper presents the results of a qualitative analysis of interviews with chaplains working to promote community health and wellness (n = 10). The identified themes highlight factors at the individual chaplain level, such as how chaplains got involved, characteristics of the chaplains’ contexts, and the impact of chaplains’ involvement.

Addressing Social Determinants of Health in Primary Care Patients May Reduce Hospital Readmissions: A Quasi-Experimental Study.

Health care systems are increasingly partnering with community-based organizations to address social determinants of health (SDH). We established a program that educates and connects patients with SDH needs at a primary care clinic to community services and facilitated referrals. To evaluate the effect of addressing SDH soon after discharge on hospital readmission in a clinic population. Pre/post, quasi-experimental design with longitudinal data analysis for quality improvement. Clinic patients (n = 754) having at least one hospital discharge between June 1, 2020, and October 31, 2021, were included. Of these, 145 patients received the intervention and 609 served as comparison. A primary care liaison was employed to assess and educate recently discharged clinic patients for SDH needs and refer them for needed community services from June 1, 2020, to October 31, 2021. Hospital readmissions within 30, 60, and 90days of discharge were tracked at 6-month intervals. Covariates included patient age, sex, race/ethnicity, insurance status, income, Hierarchical Condition Category risk scores, and Clinical Classification Software diagnosis groups. Data for all hospital discharges during the intervention period were used for the main analysis and data for the year before the intervention were extracted for comparison. Overall, patients in the intervention group were older, sicker, and more likely to have public insurance. The reductions in 30-, 60-, and 90-day readmissions during the intervention period were 14.39%, 13.28%, and 12.04% respectively in the intervention group, while no significant change was observed in the comparison group. The group difference in reduction over time was statistically significant for 30-day (Diff = 12.54%; p = 0.032), 60-day (Diff = 14.40%; p = 0.012), and 90-day readmissions (Diff = 14.71%; p = 0.036). Our findings suggest that screening clinic patients for SDH, and educating and connecting them to community services during post-hospital care may be associated with reductions in hospital readmissions.

The Role of Social Determinants of Health in Self-Reported Psychological Distress among United States Adults Post-COVID-19 Pandemic

Psychological distress, an emotional condition with symptoms of anxiety and depression, leads to impaired function, behavior, and personal traits. The current study examined the association between social determinants of health and the severity of psychological distress among adults in the United States after the COVID-19 pandemic. Using multinomial multivariable logistic regression, we analyzed data from 5106 (n = 5106) participants in the Health Information National Trends Survey (HINTS) 6. Compared to non-Hispanic Whites, African Americans (AOR = 0.62, CI = 0.42–0.93) had lower odds of reporting mild psychological distress rather than no stress. Other variables associated with a higher likelihood of reporting moderate to severe psychological distress, rather than no distress, are being in the 50–64 years age group (AOR = 2.77, CI = 1.45–5.28), divorced (AOR = 2.50, CI = 1.70–3.69), and widowed (AOR = 3.78, CI = 2.15–6.64). Respondents living in an urban area had lower odds of reporting moderate to severe psychological distress (AOR = 0.56, CI = 0.39–0.80) compared to those living in rural areas. Our findings identify several risk factors for psychological distress by sociodemographic characteristics such as age, race, marital status, and urban living, providing empirical evidence for interventions in behavioral health. These findings suggest there is an utmost need for a multi-sectoral approach to address the social determinants of health associated with psychological distress post-COVID-19 pandemic.

Examining Financial Strain and Subjective Social Status in Terms of Behavioral Health Among Latinx Adults in a Federally Qualified Health Center.

There is a growing recognition that Social Determinants of Health (SDoH) can inform some sources of physical and mental health disparities among the Latinx population. The current study sought to expand previous research by exploring the singular and interactive influence of financial strain and subjective social status-two common and clinically important SDoH factors-on pain intensity, pain disability, general depression, social anxiety, and anxious arousal. The current sample consisted of 155 Latinx adults (81.3% female; Mage = 40.02years, SD = 10.61) presenting for care at a Federally Qualified Health Center (FQHC). Multivariate results demonstrated that financial strain was statistically significantly associated with greater pain intensity, pain disability, general depression, and anxious arousal, but not social anxiety. Further, lower subjective social status was related to greater general depression, social anxiety, and anxious arousal but not with higher levels of pain indices. An interactive effect was found wherein the combination of higher levels of financial strain and low levels of subjective social status was related to general depression and anxious arousal. This is the first study to empirically evaluate the main and interactive effects of financial strain and subjective social status regarding numerous physical and mental health symptoms. These findings clarify how two prevalent SDoH factors influence health outcomes. Specifically, the results suggest that a multi-risk conceptualization can advance a fine-grained understanding of Latinx health disparities by showing differential associations between SDoH factors and clinical outcomes that are frequently the source of health inequities in the Latinx population.

County-Level Enrollment in Medicare Advantage Plans Offering Expanded Supplemental Benefits

Since 2019 and 2020, Medicare Advantage (MA) plans have been able to offer supplemental benefits that address long-term services and supports (LTSS) and social determinants of health (SDOH). To examine the temporal trends and geographic variation in enrollment in MA plans offering LTSS and SDOH benefits. This cross-sectional study used publicly available data to examine changes in beneficiary enrollment and plan offerings of LTSS and SDOH benefits from the benefits data from the second quarter of each year and other data from April of each year except 2024, for which the first quarter was the latest for benefits data and January the latest for other data at the time of analysis. Multivariable linear regression models for each type of benefit were used to investigate associations between county characteristics and enrollment in 2024. Analyses were stratified for (1) Dual Eligible Special Needs Plans (D-SNPs) that exclusively enroll dual-eligible beneficiaries and (2) non-D-SNPs. The percentage of MA enrollees in plans offering LTSS or SDOH benefits at the county level. This study included 2 631 697 D-SNP and 20 114 506 non-D-SNP enrollees in 2020, which increased to 5 494 426 and 25 561 455, respectively, in 2024. From 2020 to 2024, the percentage of D-SNP enrollees in plans offering SDOH benefits increased from 9% to 46%, whereas the percentage fluctuated between 23% and 39% for LTSS benefits. There was an increase in non-D-SNP enrollees with LTSS (from 9% to 22%) and SDOH (from 4% to 20%) benefits from 2020 to 2023, which decreased in 2024. In 2024, the most offered LTSS benefit was in-home support services, and the most offered SDOH benefit was food and produce. The percentage of enrollees with these benefits varied across counties in 2024. In multivariable linear regression models, among D-SNPs, enrollment in plans offering any SDOH benefits was higher in counties with greater MA penetration (coefficient, 5.0 percentage points [pp] per 10-pp change; 95% CI, 2.1-7.9 pp), in urban counties (coefficient, 7.2 pp vs rural counties; 95% CI, 3.8-10.6 pp), in counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.2-3.9 pp), and in counties in states with approved Medicaid home- and community-based services waivers for individuals 65 years or older or those with disabilities (coefficient, 10.8 pp; 95% CI, 4.0-17.6 pp). Enrollment in D-SNPs offering LTSS benefits was also higher in counties with greater MA penetration (coefficient, 5.9 pp per 10-pp change; 95% CI, 2.4-9.5 pp), urban vs rural counties (coefficient, 4.6 pp; 95% CI, 1.1-8.1 pp), and counties with greater enrollment in fully integrated D-SNPs (coefficient, 3.0 pp per 10-pp change; 95% CI, 2.1-3.9 pp) in addition to counties with greater social vulnerability scores (coefficient, 1.4 pp per 10-pp change; 95% CI, 0.3-2.5 pp). In this cross-sectional study of MA plans and enrollees, an increase in enrollment was most consistent in D-SNPs offering SDOH benefits compared with LTSS benefits and in D-SNPs compared with non-D-SNPs. Geographic variation in enrollment patterns highlights potential gaps in access to LTSS and SDOH benefits for rural MA beneficiaries and dual-eligible enrollees living in counties with lower enrollment in fully integrated D-SNPs and states with more limited Medicaid home- and community-based services coverage.

Psychometric properties of the social determinants of health questionnaire (SDH-Q): development and validation

BackgroundThe influence of social determinants of health (SDH) on sustainable development goals (SDG) has gained attention in recent years. However, there is a scarcity in the availability of valid and reliable instruments to assess the multiple aspects of SDH. Hence, this study was conducted to develop a brief self-reported measure for assessing SDH.MethodA cross-sectional survey was conducted among university undergraduate students in Nigeria. The study consisted of 300 participants in the EFA (males 55.7%, females 44.3%) and 430 participants in the CFA (males 54.0%, females 46.0%). Participants were selected using a convenience sampling approach to assess their perceptions regarding SDH. Content Validity Index (CVI), Face Validity Index (FVI), Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Composite Reliability (CR), Average Variance Extracted (AVE), Cronbach’s alpha, and Intraclass Correlation Coefficient (ICC) were computed to determine the psychometric properties of the newly developed SDH scale.ResultsIn the EFA, two factors were extracted (structural determinants of SDH and intermediary determinants of SDH), with all 20 items retained. The total variance explained by the EFA model was 61.8%, and the factor correlation was 0.178. The Cronbach’s alpha values of the two factors were 0.917 and 0.939. In the CFA, the initial model did not fit the data well based on fit indices. After several re-specification of the model, the final re-specified measurement model demonstrated adequate fit factor structure of the SDH scale with two factors and 20 items (CFI = 0.943, TLI = 0.930, SRMR = 0.056, RMSEA = 0.053, RMSEA p-value = 0.220). The CR was 0.797 for structural determinants of SDH and 0.794 for intermediary determinants of SDH. The ICC was 0.938 for structural determinants of SDH and 0.941 for intermediary determinants of SDH.ConclusionThe findings indicate that the SDH scale has adequate psychometric properties and can be used to assess the perceived level of SDH. We recommended that this tool be tested in other populations with diverse age groups and other demographic characteristics.

On the development and validation of large language model-based classifiers for identifying social determinants of health

The assessment of social determinants of health (SDoH) within healthcare systems is crucial for comprehensive patient care and addressing health disparities. Current challenges arise from the limited inclusion of structured SDoH information within electronic health record (EHR) systems, often due to the lack of standardized diagnosis codes. This study delves into the transformative potential of large language models (LLM) to overcome these challenges. LLM-based classifiers-using Bidirectional Encoder Representations from Transformers (BERT) and A Robustly Optimized BERT Pretraining Approach (RoBERTa)-were developed for SDoH concepts, including homelessness, food insecurity, and domestic violence, using synthetic training datasets generated by generative pre-trained transformers combined with authentic clinical notes. Models were then validated on separate datasets: Medical Information Mart for Intensive Care-III and our institutional EHR data. When training the model with a combination of synthetic and authentic notes, validation on our institutional dataset yielded an area under the receiver operating characteristics curve of 0.78 for detecting homelessness, 0.72 for detecting food insecurity, and 0.83 for detecting domestic violence. This study underscores the potential of LLMs in extracting SDoH information from clinical text. Automated detection of SDoH may be instrumental for healthcare providers in identifying at-risk patients, guiding targeted interventions, and contributing to population health initiatives aimed at mitigating disparities.

Social Determinants of COVID-19 Pandemic Control: Participatory Learnings From Everyday Experiences in Cape Town, South Africa.

As countries adapted their disaster responses to the COVID-19 pandemic, South Africa responded with an alert-level risk approach based on epidemiological principles that impacted all societal levels. We explored the everyday experiences of people in Cape Town whose basic needs were met and who could report on the realities of the COVID-19 pandemic control. Gaining insight into their perspectives contributes to knowledge that can inform policies and practices for managing future public health crises. Community-Based Participatory Research principles guided the design and a series of facilitated dialogues with 18 research participants. The thematic analysis was deepened through two colloquiums with members of an overarching research consortium and a participant reflection workshop. The pandemic impacted individuals, their interpersonal relationships, workplaces and communities, leading to societal processes such as stigma, virtue signalling and the subversion of mandates. The public health response had mixed reactions, with useful information about preventive measures being diluted by COVID-19 denialism and fake news. Health and other authorities were frequently perceived as out of touch with, and unresponsive to, the everyday realities of local communities. Our study demonstrates the connectedness of people and the need to maintain and re-establish severed connections. A holistic approach to health care and promotion from social determinants of health and a community-engaged perspective may significantly increase the outcomes of public health responses. People with everyday experience of the COVID-19 pandemic-including community members, healthcare workers, case managers, carers and researchers-collaborated on the study design, interview schedule, data interpretation, analysis and refinement of this article.

Global emergency medicine research priorities: a mapping review.

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world.