Wen Wan, PhD; Vivian Li, MS; Marshall H. Chin, MD, MPH; Dave Faldmo, MD; Erin Hoefling, RN; Michelle Proser, PhD; Rosy Chang Weir, PhD
Corresponding Author: Wen Wan, PhD; University of Chicago.
Contact Email: wwan1@medicine.bsd.uchicago.edu
Section: Original Research
Published Version: www.jabfm.org/content/35/4/668
INTRODUCTION: PRAPARE is a leading social risk screening tool. No studies yet have simplified the 22 PRAPARE social determinants of health (SDOH) into clusters to analyze associations with chronic disease outcomes.
METHODS: Federally qualified health center conducted cross-sectional PRAPARE screening on its general adult population. Exploratory and confirmatory factor analyses were used to identify SDOH clusters, and construct cluster scores and SDOH total risk scores. Both Cronbach’s alpha and the greatest lower bound were calculated for the internal consistency reliability. Logistic regression assessed relationships between cluster scores and uncontrolled diabetes (HbA1c ≥ 9%) and/or hypertension (≥140/90 mmHg).
RESULTS: 11,773 adults answered the survey: 716 with diabetes only, 2,388 with hypertension only, 1,477 with both, and 7,192 with neither. We found three composite SDOH clusters (social background, social insecurities, insurance/employment) and three standalone clusters (housing status, social isolation, poverty). The Cronbach’s alpha was 0.86, and the greatest lower bound was 0.935. Among patients with diabetes, those at risk in social background (odds ratio (OR) = 1.12, 95% CI 1.02-1.23), social insecurities (OR = 1.18, 95% CI 1.05-1.32), and insurance/employment (OR = 1.24, 95% CI 1.06-1.47) were more likely to have uncontrolled diabetes. Among patients with hypertension, those at more risk in social insecurities (OR = 1.16, 95% CI 1.06-1.26) were more likely to have uncontrolled hypertension.
CONCLUSIONS: We simplified the 22 PRAPARE SDOH into three composite clusters and three individual clusters, and demonstrated the reliability and validity of PRAPARE. The three composite clusters were positively associated with uncontrolled diabetes and hypertension.