Association of Social Needs with Diabetes Outcomes in an Older Population.

Abstract

Background: Identifying and addressing social needs is important to improve health for older adults with type 2 diabetes mellitus (T2DM). However, few studies have examined the association between social needs and T2DM-related outcomes among older populations within integrated health care systems. This study examined the association between social needs and DM-related outcomes among older adults with T2DM receiving care at Kaiser Permanente Northwest.

Methods: From a cohort of 1954 Medicare members ages 65 and older who completed a social needs questionnaire, we examined the association between 5 dichotomous (yes vs no) social needs measures (financial strain, food insecurity, housing instability, social isolation, and transportation needs) and 3 DM-specific outcomes in the 12 months after assessment: 1) good glycemic control (HbA1c < 8%); 2) any DM-specific emergency department (ED) utilization; and 3) any DM-specific hospital admissions.

Results: About 40% of the study population reported 1 or more social needs. Financial strain (OR = 0.56, 95% CI = 0.36-0.85), food insecurity (OR = 0.47, 95% CI = 0.28-0.81) and housing instability (OR = 0.50, 95% CI = 0.25-0.99) were associated with lower odds of good glycemic control. All 5 social needs were associated with higher ED utilization (financial strain: OR = 1.65, 95% CI = 1.17-2.33; food insecurity: OR = 1.62, 95% CI = 1.02-2.57; housing instability: OR = 2.14, 95% CI = 1.23-3.75; social isolation: OR = 1.36, 95% CI = 1.06-1.74; transportation needs: OR = 1.83, 95% CI = 1.23-2.71). Financial strain was also associated with higher hospital admissions (OR = 1.77, 95% CI = 1.17-2.68).

Discussion: Associations between social needs and DM-specific outcomes demonstrate the need to develop programs to address social needs in the clinical setting and test whether such interventions improve DM-related outcomes.