Unmet social needs among low-income adults in the United States: Associations with health care access and quality.
Unmet social needs among low-income adults in the United States: Associations with health care access and quality.
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DOI：
10.1111/1475-6773.13555
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发表时间：
2020-10
影响因子：
3.4
通讯作者：
Nguyen KH
中科院分区：
文献类型：
--
作者：
Cole MB;Nguyen KH
描述低收入成年人的社会需求，并估计未满足的社会需求水平与卫生保健获取和质量的关键指标之间的关系。来自2017年行为风险因素监测系统的12个州的全国调查数据，该系统在2017年增加了“健康的社会决定因素”模块。我们检查了基于7项社会需求指标的0、1、2 - 3和4+未满足社会需求的低收入成年人在8项医疗保健可及性和质量指标（例如，过去12个月内的检查、因费用而无法看医生、接受糖尿病眼科检查）方面的差异。我们使用调整后的逻辑回归模型来估计未满足需求水平与每种结局之间的关联。最常见的未满足的社会需求包括没有足够的钱购买均衡膳食（33%）或食物（32%）。在调整可观察到的特征后，较高水平的未满足社会需求与较差的获取和质量相关。与没有报告未满足需求的患者相比，4+未满足需求与每年检查的可能性降低显著相关（65%对78%，调整后的差异=-7.1个百分点（PP）），接受流感疫苗（33%对42%，调整后的差异=-5.4 PP），有私人医生（74%对80%，调整后的差异=-3.1 PP），（63% vs 80%，调整后的差异=-12.8 PP）或眼部检查（61%对73%，调整后的差异=-12.6 PP），由于费用原因无法看医生的可能性增加（44%对9%，调整后的差异= 27.9 PP），糖尿病影响眼睛（22%对19%，调整后的差异= 8.0 PP），α = 0.05。未满足的社会需求水平较高，与低收入成年人获得护理的机会和质量较差有关。满足医疗机构内外的社会需求可能有助于减轻这些负面影响。关于是否以及如何有效地这样做的进一步研究至关重要。
To describe social needs among low‐income adults and estimate the relationship between level of unmet social needs and key indicators of health care access and quality. National survey data from 12 states from the 2017 Behavioral Risk Factor Surveillance System, which added a “Social Determinants of Health” Module in 2017. We examined differences in eight measures of health care access and quality (eg, check‐up in last 12 months, inability to see doctor due to cost, receipt of eye examination for diabetics) for low‐income adults with 0, 1, 2‐3, and 4+ unmet social needs based on 7 social needs measures. We used adjusted logistic regression models to estimate the association between level of unmet need and each outcome. Most common unmet social needs included not having enough money for balanced meals (33 percent) or food (32 percent). After adjusting for observable characteristics, higher levels of unmet social need were associated with poorer access and quality. Compared to those with no reported unmet needs, having 4+ unmet needs was significantly associated with reduced probability of having a yearly check‐up (65 percent vs 78 percent, adjusted difference = −7.1 percentage points (PP)), receiving a flu vaccine (33 percent vs 42 percent, adjusted difference = −5.4 PP), having a personal doctor (74 percent vs 80 percent, adjusted difference = −3.1 PP), and having a foot (63 percent vs 80 percent, adjusted difference = −12.8 PP) or eye examination (61 percent vs 73 percent, adjusted difference = −12.6 PP) for diabetic patients, and increased probability of being unable to see a doctor due to cost (44 percent vs 9 percent, adjusted difference = 27.9 PP) and having diabetes affect the eyes (22 percent vs 19 percent, adjusted difference = 8.0 PP) at α = 0.05. Higher levels of unmet social needs were associated with poorer access to and quality of care among low‐income adults. Addressing social needs both inside and outside of health care settings may help mitigate these negative effects. Additional research on if and how to effectively do so is critical.
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