The social
determinants of health were significantly associated with the development of
chronic disease.
By Jessica
Kent
May 23,
2019 - Individuals’ social determinants of health, including
education level, income, diet, and exercise, were strongly associated with the
development of a chronic disease, suggesting that providers should assess these
factors to identify high-risk patients, according to a study published in JAMA Network
Open.
Healthcare
organizations are increasingly recognizing the critical role social and
behavioral factors play in patients’ overall health, the researchers noted.
“Payment models
rewarding good health outcomes rather than simply reimbursing for provision of
services have created incentives for practitioners to prevent the onset of
disease, slow its progression, and minimize complications,” the group said.
“Recognizing the
influence of social and behavioral factors on all three stages, healthcare
systems are increasingly screening for social and behavioral factors associated
with health.”
Recently, the
National Academy of Medicine (NAM) recommended a set of measures that
represent social and behavioral factors that
impact overall wellness. The team set out to determine whether the NAM social
and behavioral factors are linked to the development of diabetes and
hypertension during 3.5 years of follow-up.
The study included
18,133 people without baseline hypertension and 35,788 people without baseline
diabetes.
Overall, 1163
patients, or 6.4 percent, developed hypertension by the end of the follow-up
period, ranging from 183 of those with no social or behavioral risk factors to
307 of those with three or more risk factors.
Of those without
baseline diabetes, 1442, or four percent, developed diabetes, ranging from 203
patients with no social or behavioral risk factors to 445 patients with three
or more risk factors.
The results showed
that having less than a high school education level, being widowed,
concentrated neighborhood poverty, infrequent exercise, and smoking were
significantly associated with hypertension onset.
Having less than a
high school education level, financial worry, being single or separated, high
stress, concentrated neighborhood poverty, and depressive symptoms were
significantly associated with diabetes onset.
Researchers also
found that all nonwhite racial and ethnic groups were at higher risk of
developing both hypertension and diabetes than white individuals.
Additionally, after
conducting sensitivity analyses, the team saw that there was an association
between an increasing number of social and behavioral risk factors and
increased likelihood of disease.
These results may
provide insight for organizations and clinicians looking to screen patients’ social determinants.
“A wide range of
healthcare professionals and systems are grappling with whether to screen for
social and behavioral risk factors, for which social and behavioral risk
factors they should screen, and whom they should screen,” the researchers said.
“Supporting the value
of using the NAM measures in a clinical setting, the findings of the current
study provide relevant evidence on each of those questions.”
Regarding whether
providers and organizations should screen their patients, researchers said that
in samples of patients with no evidence of hypertension or diabetes at
baseline, social and behavioral risk factors were associated with disease onset after
a relatively short period. The finding suggests that providers can use this
information to better target their resources to patients who need tailored
care.
The results also
support screening for a range of NAM-endorsed social and behavioral risk
factors. The team said that because patients with higher overall social and
behavioral risk factor scores were at greater risk of disease onset regardless
of the specific factors reported, organizations may want to employ broad
screening tactics.
As for who should be
screened, the researchers noted the findings challenge the notion that
screening for social and behavioral risk factors is unnecessary outside safety-net settingsbecause the study
sample represented a diverse insured population.
“As more
practitioners screen for social and behavioral risk factors, it will be
increasingly important to gain consensus on standard measures with
evidence-based cut points, which would expedite data sharing across facilities
to improve clinical care and facilitate development and evaluation of
predictive models,” the team said.
“The adoption of EHRs
has permitted access to an ever-expanding amount of data and aided the
development of precision medicine. As interventions become increasingly
individualized, it will be important to include social and behavioral risk
factors in addition to traditional biometric data.”
The researchers noted
that their study as limited in that the sample of patients was small and not
nationally representative, which could limit the generalizability of the
findings.
Still, the team said
that their results show that the social determinants of health play a crucial
role in patients’ overall health and wellness.
“The current study
underscores the potential importance of knowing social and behavioral
information in both clinical and healthcare system settings and advocates for
exploring the utility of routine collection of this information. There will be
logistical challenges to accomplishing this, but our findings support the
potential value of doing so,” researchers concluded.
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