RISE rounds up recent headlines concerning social determinants of health (SDoH).
AMA urges health plans to address SDoH as part of health insurance coverage
During the Special Meeting of the American Medical Association (AMA) House of Delegates last week, physicians adopted policies to address SDoH as part of health insurance coverage. The new policies were recommended to eliminate inequities through advocacy, community leadership, and education.
“Addressing social determinants of health requires an all-hands-on-deck approach that is not limited to stakeholders within the health care system,” said David H. Aizuss, M.D., a member of the AMA Board of Trustees. “By addressing social determinants of health in their benefit designs and coverage, health plans can be part of the effort to improve patient health outcomes.”
The adopted policies aim to:
- Encourage new and continued partnerships among all levels of government, the private sector, philanthropic organizations, and community- and faith-based organizations to address non-medical, yet critical health needs and underlying SDoH
- Support continued efforts by public and private health plans to address SDoH in health insurance benefit designs
- Encourage public and private health plans to examine implicit bias and the role of racism and SDoH, including mechanisms such as professional development and other training
- Support methods, including the establishment of incentives, to improve the acquisition of data related to SDoH
- Encourage pilot programs to assess the impacts of addressing certain nonmedical, yet critical health needs
Food insecurity found to increase risk of cardiovascular death
Study findings from The American Heart Association Scientific Sessions show a link between increased food insecurity and cardiovascular death.
To better understand the connection, researchers utilized the National Center for Health Statistics and the Map the Meal Gap study to assess cardiovascular death rates and food insecurity rates from 2011 to 2017 among adults age 20 to 64, as well as adults age 65 and older.
- Food insecurity rates in the U.S. declined significantly between 2011 to 2017.
- The level of food insecurity was a significant predictor of cardiovascular death for people between the ages of 20 and 64.
- S. counties with the highest increase in food insecurity saw an increase in cardiovascular death rates (82 percent to 87 percent per 100,000 population). Counties with a decrease in food insecurity had a cardiovascular death rate that remained stable.
- Cardiovascular death rates among adults age 65 and older remained significantly higher than for individuals age 64 and younger, but the rate of deaths declined from 1,643 to 1,542 per 100,000 population among those who experienced the most change in food insecurity and from 1,408 to 1,338 per 100,000 population among those who had the least change.
- For every 1 percent increase in food insecurity, there was a similar increase in cardiovascular death rates among non-elderly adults.
"This research shows food insecurity, which is a particular type of economic distress, is associated with cardiovascular disease,” said study co-author Sameed Khatana, M.D., M.P.H., instructor of cardiovascular medicine, Perelman School of Medicine at the University of Pennsylvania in Philadelphia, said in the study announcement. “It illustrates that cardiovascular health is tied to many things. It's more than doctors' visits, screenings, medications, and procedures; what is going on outside the clinic, in society, has a significant impact on patients’ health, too."
Patient screenings for SDoH found more effective than community-based data
A recent report from JAMA network suggests patient-level and community-level approaches to identify social risk are not equal, and relying on community-level data to steer patient-level activities may overlook patients.
The report, which was published at the end of October, analyzed the efficiency of community-level data to accurately identify patients with social risks by comparing the social deprivation index score for the census tract where a patient lives with patient-level social risk screening data.
The study evaluated 36,578 patients from 13 states, including individuals who received public insurance (60.5 percent), were female (57.9 percent), were white (48.1 percent), and were Black (29.8 percent). Of the total patients, nearly 30 percent (10,858) screened positive for one or more social risks. Of those patients, 42 percent lived in neighborhoods not defined as disadvantaged and would not have been included in social risk-targeted care.
“Using community-level social risk data to guide patient-level activities may mean that some patients who could benefit from programs targeting social conditions or care adjustments would not be identified,” wrote study authors.