LONGITUDINAL PATTERNS OF POPULATION AND INDIVIDUAL-LEVEL HEALTH-RELATED SOCIAL NEEDS

ABSTRACT

BACKGROUND: While almost half of US adults report a health-related social need (HRSN), little is known about how an individual's HRSNs change over time. Existing research on HRSNs has mostly focused on cross-sectional studies and has been geographically localized. To overcome these limitations, we examined longitudinal patterns of HRSNs among a large nationwide cohort of Medicare beneficiaries. METHODS: We used data from a longitudinal nationwide cohort of individuals ≥65 years of age enrolled in Humana Medicare Advantage plans. Four surveys were administered approximately quarterly between Q4 2019 to Q4 2020 and asked validated questions about financial strain, food insecurity, loneliness or social isolation, housing insecurity, poor housing quality, utility insecurity, and unreliable transportation. We restricted our analyses to those who responded at least in part to all 4 surveys. We used Sankey plots to visualize transitions in individual patients' total number of reported HRSNs over time. We also used baseline patient characteristics drawn from medical and pharmacy claims data to characterize 3 distinct groups 1) no HRSN across all quarters, 2) any fluctuation between 0 and ≥1 HRSN, and 3) ≥1 HRSN across all quarters. RESULTS: Of 18,881 individuals, the overall number reporting HRSNs was relatively consistent over time. Specifically, financial (29.6-31.3%), food (18.7-19.8%), and housing quality (15.9-17.3%) were the most frequent needs across each quarter. However, when characterized at the individual level, patients reported substantial fluctuations in need 27.7% reported no HRSNs in all four quarters;45.5% fluctuated between having 0 and ≥1 HRSN across the four quarters;26.8% reported ≥1 HRSN in all 4 quarters. For example, of those who reported one HRSN in Q1, 44.8% transitioned to no need in Q2. Demographic and clinical characteristics differed across the three groups. For example, female gender, Black race/ethnicity, residence in the South, and higher comorbidity burden were disproportionately represented in those reporting ≥1 HRSN in each quarter, followed by those with fluctuating needs. CONCLUSIONS: In this nationwide survey of health-related social needs among Medicare beneficiaries, while the overall prevalence of HRSNs was consistent over time, we observed marked fluctuation in individuals' needs during the year observed. This fluctuation occurred over all quarters and did not change after the COVID-19 pandemic began. Our findings have important ramifications for health systems or communities that wish to offer support for these patients. In some populations, screening for needs may have to happen more frequently than typically done at present. Support may need to be offered rapidly as patients experience a change in need. Key demographic and clinical characteristics also appear to differ for patients experiencing consistent or fluctuating needs, which could be used as potential identifiers for those at greatest need.