Abstract
Background
Social determinants of health (SDH) are strong predictors of morbidity and mortality
but health care systems struggle to integrate documentation of SDH into health records
in ways that can be used for health services research. Given the impact of social
factors on health, it is important to examine the relationship with emergency department
(ED) utilization.
Objective
To examine the association between seven indicators of SDH and ED utilization using
electronic health record (EHR) data from the Veterans Health Administration (VHA).
Methods
This cross-sectional analysis included data from all patients who had at least one
health care visit in the Veterans Integrated Service Network region 4 from October
1, 2015 through September 30, 2016 (n = 293,872). Seven categories of adverse SDH included violence, housing instability,
employment or financial problems, legal problems, social or family problems, lack
of access to care or transportation, and non-specific psychosocial needs identified
through structured coding in EHR. Negative binomial regression was used to examine
the association of the count of adverse SDH (0–7) with the count of ED visits, adjusting
for socio-demographic and health-related factors.
Results
Approximately 18% of patients visited the ED during the observation period. After
adjusting for covariates, adverse SDH were positively associated with VHA ED utilization.
Each of the SDH indicators, other than legal issues, was positively associated with
increased ED utilization.
Conclusion
Even after accounting for several demographic and health-related factors, adverse
SDH demonstrated strong positive associations with VHA ED utilization.
Keywords
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Article Info
Publication History
Published online: May 26, 2020
Accepted:
May 20,
2020
Received in revised form:
May 19,
2020
Received:
March 22,
2020
Identification
Copyright
Published by Elsevier Inc.
