The association of social determinants of health with health outcomes.

Krause, Trudy Millard; Schaefer, Caroline; Highfield, Linda

OBJECTIVES This study explored the contributions of social determinants of health (SDOH) to measures of population health-specifically cost, hospitalization rates, rate of emergency department utilization, and health status-in Texas. STUDY DESIGN The study associated common SDOH metrics from public data sources (county specific) with health plan enrollment data (including demographics, counties, and zip codes) and medical and pharmaceutical annual claims data. METHODS Following correlation analyses to reduce variables, the contribution of each SDOH individually and by category to the health outcomes was evaluated. Separate matrices for age populations (under age 19, general population [all ages], and ≥ 65 years) were created with assigned weights of influence for categories and the factors within each category. RESULTS The contributions of the categories varied by population, confirming that different SDOH influence populations to varying degrees. This was reflected in each model. The largest contributor to cost for the general population and for the group 65 years and older was factors grouped as health outcomes (such as perceived health), at 43.5% contribution and 37.7% contribution, respectively. Yet for the population younger than 19 years, the largest contributor to cost was socioeconomic factors (such as unemployment rate), at 40.2%. The other performance measures also varied by population and the mix and weight of determinants. CONCLUSIONS This study and the developed population-based matrices can provide a valuable framework for reporting the impact of SDOH on health care quality. The variation suggests the need for further research on how age groups react to the social environment.