63 The Impact of the COVID-19 Pandemic on Social Determinants of Health on Patients in a Rural Academic Emergency Department

Findlay, S.; Okoro, U.; Lee, S.; Harland, K.; Evers, M.; Dang, E.; McCormick, M.; Buresh, C.

Background: Stay-at-home orders and social distancing recommendations, combined with COVID-19 concerns, have caused significant disruptions in daily life. Throughout the pandemic, vulnerable populations, commonly seen within the University of Iowa emergency department, have been more negatively affected by COVID-19. Study Objectives: To assess how the social needs of the population cared for within the University of Iowa emergency department have changed in response to the COVID-19 pandemic. Methods: The Center for Medicare and Medicaid and Services (CMS) social risk assessment was adapted, covering 13 specific domains, to assess changes to participants’ social situations throughout the COVID-19 pandemic dated from January 2020 to February 2021. It was administered within the emergency department to individuals selected by a convenience sample who were stable enough to complete the form. Frequencies with percentages, fisher’s exact test, logistic regression were used to analyze the categorical data. Dependent variables of interest were analyzed by age group, sex, and race. Results: A total of 305 patients were approached and 207 (68%) responses were received. Of the included responses 7/177 (4%) identified as Hispanic or Latino, 15/175 (8.6%) as Black or African American, and 151/175 (86.3%) as white. The survey respondents indicated that 7.1% had worsened employment situation in comparison to before COVID-19. Moreover, 14.5% found it harder to pay for basics such as food, housing, medical care, and heating compared to prior to the pandemic, and 10.1% reported worsening lack of reliable transportation. Further, 26% stated that feelings of loneliness have worsened along with 30% reporting more stress, while 16.8% reported feelings of little interest or pleasure in doing things have improved along with 20.8% reported feeling down, depressed, or hopeless also improved in comparison to before the pandemic. Lastly, 2.5% stated their physical safety had worsened and 6.5% were experiencing worsening verbal abuse. The logistic regression showed that the odds ratio (95% CI) for increased financial difficulty for Non-Caucasians vs Caucasians is 10.5 (2.7 -40.3) and the odds ratio (95% CI) for increased financial difficulty for females vs males is 2.9 (1.1 – 7.7). Conclusion: The COVID-19 pandemic led to overall greater financial instability and increased stress. Non-Caucasians and females were more likely to report that their financial situations worsened. Isolation, stress, and forms of abuse were also found to worsen. Nevertheless, symptoms of worsening depression were found to be improve among our study population. In light of these findings, it is important to understand how the pandemic affected numerous social determinants of health, especially for individuals who were already experiencing unmet social needs. With a better understanding of the health needs of our population, identifying strategies to improve overall wellness can be better achieved.