Social Determinants of Health Are Associated With Visits for Ambulatory Care Sensitive Conditions.

ABSTRACT

OBJECTIVES: Population health experts have described the link between social factors and health, but few studies link specific social needs to disease processes. Nationwide Children's Hospital implemented a universal, annual screener for social determinants of health (SDH) in 2018. Early analyses have shown that patients identifying an SDH need were more likely to have an emergency department (ED) or inpatient stay. The objective of this study is to identify links between SDH and ED presentation for ambulatory care sensitive conditions (ACSCs). METHODS: This was a retrospective observational study of children aged 0-21 years receiving care at Nationwide Children's Hospital from 2018 to 2021 that were screened for SDH. Acute care utilization within 6 months of screener completion, sociodemographic, and clinical data were collected via EPIC data extraction. Patients that completed screening tool for the first time in the ED were excluded to minimize selection bias. Logistic regression was used to analyze the association between ED presentation for ACSCs and SDH needs. RESULTS: A total of 108,346 social determinants screeners were included with 9% of screeners identifying a need. Five percent of the population expressed food needs, 4% transportation needs, 3% utility needs, and 1% housing needs. Eighteen percent of patients had an ED visit for ACSC, with the most common complaints being upper respiratory infections and asthma. Having any SDH need was associated with ED visits for ACSCs (odds ratio, 1.12; 95% confidence interval, 1.06-1.18). Needs in all domains were significantly associated with increased visits for ACSCs; however, patients with housing needs had the highest odds of utilization (odds ratio, 1.25; confidence interval, 1.11-1.41). CONCLUSIONS: The odds of ED presentation for ACSCs are higher in patients with expressed social needs. Further delineating the connections between specific SDH and health outcomes can inform timely and appropriate interventions.