Faculty Collaboration Database

Social Risk Factor Domains and Preventive Care Services in US Adults. JAMA Netw Open 2024 Oct 01;7(10):e2437492

Date

10/04/2024

Pubmed ID

39365580

Pubmed Central ID

PMC11452812

DOI

10.1001/jamanetworkopen.2024.37492

Scopus ID

2-s2.0-85205606021 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

IMPORTANCE: Growing evidence suggests that social determinants of health are associated with low uptake of preventive care services.

OBJECTIVE: To examine the independent associations of social risk factor domains with preventive care services among US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used National Health Interview Survey data on 82 432 unweighted individuals (239 055 950 weighted) from 2016 to 2018. Subpopulations were created for each of the primary outcomes: routine mammography (women aged 40-74 years), Papanicolaou test (women aged 21-65 years), colonoscopy (adults aged 45-75 years), influenza vaccine (adults aged ≥18 years), and pneumococcal vaccine (adults aged ≥65 years). Statistical analysis was performed from July to December 2023.

EXPOSURES: Six social risk domains (economic instability, lack of community, education deficit, food insecurity, social isolation, and lack of access to care) and a count of domains.

MAIN OUTCOMES AND MEASURES: Logistic regression models were used to examine the independent association between each primary outcome (mammography, Papanicolaou test, colonoscopy, influenza vaccine, and pneumococcal vaccine) and social risk factor domains, while controlling for covariates (age, sex, race and ethnicity, health insurance, and comorbidities).

RESULTS: A total of 82 432 unweighted US individuals (239 055 950 weighted individuals) were analyzed. A total of 54.3% were younger than 50 years, and 51.7% were female. All 5 screening outcomes were associated with educational deficit (mammography: odds ratio [OR], 0.73 [95% CI, 0.67-0.80]; Papanicolaou test: OR, 0.78 [95% CI, 0.72-0.85]; influenza vaccine: OR, 0.71 [95% CI, 0.67-0.74]; pneumococcal vaccine: OR, 0.68 [95% CI, 0.63-0.75]; colonoscopy: OR, 0.82 [95% CI, 0.77-0.87]) and a lack of access to care (mammography: OR, 0.32 [95% CI, 0.27-0.38]; Papanicolaou test: OR, 0.49 [95% CI, 0.44-0.54]; influenza vaccine: OR, 0.44 [95% CI, 0.41-0.47]; pneumococcal vaccine: OR, 0.30 [95% CI, 0.25-0.38]; colonoscopy: OR, 0.35 [95% CI, 0.30-0.41]). Fully adjusted models showed that every unit increase in social risk count was significantly associated with decreased odds of receiving a mammography (OR, 0.74 [95% CI, 0.71-0.77]), Papanicolaou test (OR, 0.84 [95% CI, 0.81-0.87]), influenza vaccine (OR, 0.81 [95% CI, 0.80-0.83]), pneumococcal vaccine (OR, 0.80 [95% CI, 0.77-0.83]), and colonoscopy (OR, 0.88 [95% CI, 0.86-0.90]).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of US adults suggests that social risk factor domains were associated with decreased odds of receiving preventive services; this association was cumulative. There is a need to address social risk factors to optimize receipt of recommended preventive services.

Author List

Schroeder T, Ozieh MN, Thorgerson A, Williams JS, Walker RJ, Egede LE

Authors

Mukoso Nwamaka Ozieh MD Associate Professor in the Medicine department at Medical College of Wisconsin
Joni Williams MD, MPH Center Director, Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Colonoscopy
Cross-Sectional Studies
Female
Health Services Accessibility
Humans
Influenza Vaccines
Male
Mammography
Middle Aged
Papanicolaou Test
Pneumococcal Vaccines
Preventive Health Services
Risk Factors
Social Determinants of Health
United States
Young Adult