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Article Title

Prevalence of Social Determinants of Health in a Large Non-Safety Net Health Plan Membership

Publication Date

8-10-2017

Keywords

aging, elderly, geriatrics, survey research and methods, demographics, racial/ethnic differences in health and health care, social determinants of health, dental care, health promotion, prevention, screening

Abstract

Background: Health plans are exploring how to assess and address social determinants of health (SDOHs) in their socioeconomically diverse memberships. We used survey data to examine prevalence of SDOHs among adults in Kaiser Permanente Northern California.

Methods: SDOH prevalence among members aged 25–79 years was estimated using pooled weighted data from 2011 and 2014 Member Health Surveys (N > 22,000). SDOHs included: educational attainment, income, financial worry, reduced medical care/medication use/fruit and vegetable consumption due to cost, chronic stress, caregiver responsibilities, life satisfaction, harassment/discrimination, concern about neighborhood violence, preventive dental care, health beliefs, and ability to use the internet. Estimates were made for ages 25–64 (NS) and 65–79 (S) and evaluated for sex and racial/ethnic differences.

Results: Overall, 19% (18% of NS, 27% of S) had low educational attainment (≤ high school graduate), and 49% (51% of NS, 41% of S) were college graduates. About 9% (7% of NS, 21% of S) had a household income (HHI) of ≤ $25,000 and 15% (13% of NS, 35% of senior women, 20% of senior men) an HHI ≤ $35,000. In the past year: 13% (15% of NS, 6% of S) had forgone or delayed medical care, 7% (no age difference) had used less medication, and 9% had consumed less fruit/vegetables than they would have, each due to cost; 28% (31% of NS, 15% of S) had worried a great deal about their financial situation; 6% (7% of NS, 3% of S) had worried about neighborhood violence; 17% (23% of NS women, 16% of NS men, 6% of S) experienced chronic high stress; and 20% had no preventive dental care. Among those aged 45–79, 32% of women and 21% of men were unpaid caregivers for an ill or disabled relative. Only 36% (33% of NS, 48% of S) felt very satisfied with their life. About 14% do not believe health habits/lifestyle can greatly affect their health, and 16% do not believe the same for emotional troubles/stress. Ability to use the internet was high (98% of NS, 84% of S) but lower among lower-income adults. Significant racial/ethnic disparities were observed for some SDOHs.

Conclusion: SDOHs are prevalent in socioeconomically diverse (non-safety net) health plan memberships.

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