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Cited by 41Health disparities and outcomesPublic Health and Social InequalitiesHealth and Medical Studies

Self-Reported Social Determinants of Health and Area-Level Social Vulnerability

Open access
Brignone, Emily, LeJeune, Keith, Mihalko, Amanda E., Shannon, Amy L., Sinoway, Lawrence I.·2024·JAMA Network Open
DOI 10.1001/jamanetworkopen.2024.12109PMC PMC11107301
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Abstract

Importance: Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources. Objective: To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract–level social vulnerability measured using the Social Vulnerability Index (SVI). Design, Setting, and Participants: This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system. Main Outcomes and Measures: Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI. Results: In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile. Conclusions and Relevance: In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.

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  • Existing research has explored integrating patient SDoH data with geospatial datasets like census demographics and social vulnerability index (SVI) to estimate SDoH factors at a community or neighborhood level.

    “Existing research has also explored integrating patient SDoH data with geospatial datasets like census demographics and social vulnerability index (SVI) to estimate SDoH factors at a community or neighborhood level41–44.”

    From Social determinants of health extraction from clinical notes across institutions using large language models (2025) · cites this paper as [42]

    The Methods (Measures; page not provided) say patient addresses were geocoded to census tracts and joined to SVI data, and the Discussion reports associations between self-reported needs and community vulnerability. The paper does not describe using the combined data to estimate SDoH factors at the community or neighborhood level; that purpose goes beyond what it reports. (LLM, conf=0.85)

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  • One study analyzed the association between self-reported SDoH needs assessment by a health system and census tract-level social vulnerability measured using the SVI.

    “One such study analyzed to what extend the self-reported SDoH needs assessment by a health system are associated with census tract–level social vulnerability measured using the SVI42.”

    From Social determinants of health extraction from clinical notes across institutions using large language models (2025) · cites this paper as [42]

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Authors
Brignone, E., LeJeune, K., Mihalko, A. E., Shannon, A. L., & Sinoway, L. I.
Affiliations
  • Highmark Health Research Institute, Pittsburgh, Pennsylvania
  • Allegheny Health Network (US)
  • Social Determinants of Health Department, Highmark Health, Pittsburgh, Pennsylvania
  • Pennsylvania State University (US)
Corresponding author
Brignone, Emily
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2024-05-20
Volume
7
Issue
5
Pages
e2412109
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2024.12109
PMC
PMC11107301
OpenAlex
W4398142298
Cited by
38
References
21
Citations by year
2026: 16 · 2025: 19 · 2024: 3
FWCI
17.16
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
  • Health Sciences › Health Professions › General Health Professions › Health and Medical Studies
Keywords
social determinants of health, social vulnerability, Social Vulnerability Index, health insurance beneficiaries, health equity, healthcare resource allocation
MeSH terms
Social Vulnerability, Adult, Aged, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Needs Assessment, Self Report, Social Determinants of Health

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