Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.

Abstract

Introduction

Social health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals’ social risks such as food, housing, transportation, and financial insecurity and their interest in receiving assistance from the healthcare system (social needs) can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions.

Methods

The authors conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019–September 2020. Study inclusion was based on membership, age, address, and absence of dementia. Modified Poisson regression models estimated respondents' social risks and needs overall and within domain (food, housing, finances, or transportation) and by intersectional strata on the basis of a combination of age, income, gender, and race and ethnicity.

Results

Of 10,274 participants who completed the survey, 52% reported any social risk, and 32% had any social need. Financial strain was the most prevalent risk (44%), followed by food insecurity (31%), housing instability (17%), and transportation (7%). These intersectional analyses generated 74 intersectional groups. Across the intersectional groups, higher-income (>$50,000 per year) or older-age (>60 years) adults consistently had lower risk and need. However, this pattern varied by race and ethnicity. In particular, older and lower-income, Pacific Islander, African-American/Black, and multiracial adults had the highest estimates of social risk and need.

Conclusions

Higher risk and need among particular intersectional groups suggest the importance of tailored interventions for social needs. The high aggregate prevalence of social risks and needs suggests that system and policy changes must compliment universal and population-based social health screening and assistance interventions in healthcare organizations.