Significance of Social Determinants of Health Screening Among Opioid Use Disorder Patients

Background: Social determinants of health (SDOH) contribute to individuals’ health status and overall wellbeing. Social determinants of health include conditions and circumstances in which people live, such as access to food, housing, education, and local emergency and health services. SDOH have an especially large impact on individuals with substance use disorders, primarily in regards to access to treatment. Therefore, this study sought to identify and characterize disparities in SDOH among patients being treated for opioid use disorder (OUD) in a community health center setting.

Methods: We retrospectively reviewed all patients with a diagnosis of OUD who had screening for SDOH between January 2018 and December 2020 at Fair Haven Community Health Care (FHCHC), an urban federally qualified health center in New Haven, Connecticut. These patients were then compared to the general population of patients screened at FHCHC. Specific SDOH parameters that were evaluated included variables such as food insecurity, financial stability, housing insecurity, access to transportation, social support, and safety. Descriptive statistics on variables of interest were also computed.

Results: Between January 2018 and December 2020, 3849 patients were screened for SDOH. Of those individuals, 2189 (56.9%) were female, 843 (21.9%) were white or Caucasian, and 2013 (52.3%) spoke English. Among those, 2486 (64.5%) screened positive for at least 1 SDOH, and 1653 (43.9%) screened positive for at least 2 SDOH. In the OUD population, 133 total patients were screened for SDOH, and of those patients 114 (85.7%) screened positive for at least 1 SDOH and 95 (71.4%) screened positive for at least 2 SDOH. Safety, transportation, and food insecurity were the most significant barriers that the OUD population faced compared to the general population at FHCHC. Compared to the general population, patients with OUD scored 18.7% higher for safety, 22.8% higher for transportation, and 11% higher for food insecurity compared with the general population. Covariates such as age, gender, race/ethnicity, and general risk score (GRS) were also calculated as potential predictors of SDOH.

Conclusion: In our patient population we found that patients with an OUD were more likely to screen positive for SDOH compared with the general population. They were especially more vulnerable with respect to food security, safety and transportation barriers.

References:

References:
Islam, MM. Social Determinants of Health and Related Inequalities: Confusion and Implications. Front Public Health. 2019; 7:11.
Palmer, RC, Ismond, D, Rodriguez, EJ, Kaufman, JS. Social Determinants of Health: Future Directions for Health Disparities Research. Am J Public Health. 2019; 109:S70-S71.
Galea, S, Vlahov, D. Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Rep. 2002; 117:S135-S145.

Learning Objective: Describe the social and environmental barriers opioid use disorder patients face when accessing treatment

Describe the significance of screening opioid use disorder for social determinants of health