BRIEF REPORT
David M. Mosen, PhD, MPH; Stephanie L. Fitzpatrick, PhD; Erin M. Keast, MPH; John F. Dickerson, PhD; Briar L. Ertz-Berger, MD, MPH; Matthew P. Banegas, PhD, MPH, MS
Corresponding Author: David M. Mosen, PhD; Kaiser Permanente Center for Health Research
Email: david.m.mosen@kpchr.org
DOI: 10.3122/jabfm.2024.240139R2
Keywords: Financial Stress, Food Insecurity, Housing Instability, Integrated Health Care Systems, Medicare, Social Determinants of Health, Social Isolation, Surveys and Questionnaires, Type 2 Diabetes Mellitus
Dates: Submitted: 04-03-2024; 04-10-2024; Revised: 08-30-2024; Accepted: 09-16-2024
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: Identifying and addressing social needs is important to improve health for older adults with type 2 Diabetes Mellitus (T2DM). However, few studies have examined the association between social needs and T2DM-related outcomes among older populations within integrated health care systems. This study examined the association between social needs and DM-related outcomes among older adults with T2DM receiving care at Kaiser Permanente Northwest.
METHODS: From a cohort of 1,954 Medicare members ages 65 and older who completed a social needs questionnaire, we examined the association between five dichotomous (yes vs. no) social needs measures (financial strain, food insecurity, housing instability, social isolation, and transportation needs) and three DM-specific outcomes in the 12 months after assessment: 1) good glycemic control (HbA1c < 8%); 2) any DM-specific emergency department (ED) utilization; and 3) any DM-specific hospital admissions.
RESULTS: About 40% of the study population reported one or more social needs. Financial strain (OR=0.56, 95% CI=0.36-0.85), food insecurity (OR=0.47, 95% CI=0.28-0.81) and housing instability (OR=0.50, 95% CI=0.25-0.99) were associated with lower odds of good glycemic control. All five social needs were associated with higher ED utilization (financial strain: OR=1.65, 95% CI=1.17-2.33; food insecurity: OR=1.62, 95% CI=1.02-2.57; housing instability: OR=2.14, 95% CI=1.23-3.75; social isolation: OR=1.36, 95% CI=1.06-1.74; transportation needs: OR=1.83, 95% CI=1.23-2.71). Financial strain was also associated with higher hospital admissions (OR=1.77, 95% CI=1.17-2.68).
DISCUSSION: Associations between social needs and DM-specific outcomes demonstrate the need to develop programs to address social needs in the clinical setting and test whether such interventions improve DM-related outcomes.