Levi N. Bonnell; Abigail M. Crocker; Kathleen Kemp; Benjamin Littenberg
Corresponding Author: Levi N. Bonnell; University of Vermont. Email: levi.bonnell@med.uvm.edu
Section: Original Research
Publication: TBD
Purpose: Social determinants of health (SDH) including insecure access to food, housing, and financial resources are critical threats to overall health. We sought to examine this relationship among adult primary care patients with multiple chronic conditions. Methods: We obtained cross-sectional data on 2,763 adults with chronic medical (heart disease, diabetes, lung disease, or arthritis) and behavioral (mood disorder, insomnia, substance abuse, chronic pain, or irritable bowel syndrome) conditions or greater than two chronic medical conditions from a survey of participants in Integrating Behavioral Health and Primary Care, a multi-center randomized trial. Results: The prevalence of one or more insecurities was reported in 29% of participants, including food (13%), housing (3%), or financial (25%). Functional capacity ranged from 2.74 to 9.89 METs (median 6.05). The distribution of functional capacity was significantly lower for those with any one or more SDH than for those without (-0.88 METs (95% Confidence Interval (CI) -1.04, -0.72; P<0.001). After adjusting for age, marital status, income, and neighborhood social deprivation, the presence of one or more SDH resulted in a reduction of -0.77 METs (95% CI: -0.94, -0.61). Further, each insecurity independently affected the functional capacity in multivariable analysis (Food: -0.61 METs (95% CI: -0.82, -0.39), Housing: -0.58 METs (95% CI: -0.96, -0.20), Financial insecurity: -0.74 METs (95% CI: -0.91, -0.57), (all P<0.005)). Conclusions: Among primary care patients with chronic conditions, SDH are associated with poorer functional capacity, independent of other social and demographic factors. Primary Care offers a promising, if underused, opportunity to intervene in SDH. There is a need for future studies to explore the role of screening and intervention by primary care providers to mitigate or prevent SDH.