The Social Drivers of Health and Acute Healthcare Utilization Among a Pediatric Cohort

Background: The social drivers of health (SDoH) are largely responsible for child health inequities. Pediatric clinics are increasingly screening families for the SDoH. There are limited patient-level data from clinical settings on the association between SDoH and healthcare utilization. The objective of this study was to characterize the association between SDoH and emergency room utilization and hospitalizations using patient-level data.

Methods: Electronic health record data were extracted from one academic pediatric primary care clinic between 2017 and 2020 for children with at least 3 visits whose families had at least one documented response to an SDoH questionnaire: food insecurity, domestic violence, housing instability, transportation problems, legal issues, caregiving coping concerns or caregiver substance use concerns. Incidence rate ratios for emergency room utilization and hospitalizations for various SDoH were estimated using Poisson regression or negative binomial regression (as indicated by model goodness of fit tests) and were adjusted for age, sex, and race/ethnicity.

Results: Of the 4674 children screened, 48.6% were female; 63.7% identified as Hispanic, 21.4% as Black, 10.9% as other, and 4% as White. For the SDoH, 24.9% reported food insecurity, 1.3% domestic violence, 0.2% housing instability, 8.1% transportation problems, 0.1% legal problems, 3% caregiving coping concerns, and 19.1% caregiver substance use concerns (Table 1). All SDoH were significantly associated with emergency room utilization and hospitalizations in the unadjusted model, and only housing instability and caregiver substance use concerns were not significant in the adjusted model (Table 2). The incidence rate ratio estimate for the total number of SDoH (0-7) was 1.18 (95% CI: 1.13, 1.24; p<0.001) for emergency room utilization and 1.44 (95% CI: 1.33, 1.56; p<0.0001); for food insecurity, it was 1.20 (95% CI: 1.10, 1.31; p<0.001) for emergency room utilization and 1.24 (95% CI: 1.03, 1.48, p=0.0214) for hospitalizations.

Conclusion: The SDoH negatively impact health outcomes. At the patient-level, we found a significant association between SDoH and acute healthcare utilization. Unaddressed SDoH may drive unnecessary healthcare costs. More research is needed to determine effective interventions to address SDoH in clinical settings.