National analysis of health-related social needs among adult injury survivors.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE Journal of Trauma and Acute Care Surgery Pub Date : 2025-02-01 Epub Date: 2025-01-06 DOI:10.1097/TA.0000000000004508

Alexandra H Hernandez, Nina M Clark, Erika Bisgaard, Deepika Nehra, Barclay T Stewart, Alexander Malloy, Eileen M Bulger, Joseph L Dieleman, Douglas Zatzick, John W Scott

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Abstract

Background: Despite advances in trauma care, the effects of social determinants of health continue to be a barrier to optimal health outcomes. Health-related social needs (HRSNs), now the basis of a Centers for Medicare and Medicaid Services national screening program, may contribute to poor health outcomes, inequities, and low-value care, but the impact of HRSNs among injured patients remains poorly understood at the national level.

Methods: Using data from the nationally representative 2021 Medical Expenditure Panel Survey, injured patients were matched with uninjured controls via coarsened exact matching on age and sex. We then determined the prevalence of HRSNs based on core needs identified by Centers for Medicare and Medicaid Services: food, utilities, living situation, transportation, and personal safety. We used multivariable regression models to evaluate the association between HRSNs and health, delays in care, and emergency department visits.

Results: Overall, 43% of injured patients reported one or more HRSNs. Compared with uninjured controls, injured patients were more likely to have unmet needs in all five HRSN domains (adjusted odds ratio, 1.44-2.00; p < 0.05 for all). In stratified analyses, HRSNs were highest among patients with lower income (65.1%), those who identified as Non-Hispanic Black patients (61.3%), and patients with Medicaid (66.1%). Increasing number of HRSNs was associated with worse physical and mental health ( p < 0.05). Injured patients with three or more HRSNs were also more likely to delay care because of cost (adjusted odds ratio, 3.79; 95% confidence interval, 2.29-6.27) and had greater emergency department utilization (adjusted incidence rate ratio, 1.47; 95% confidence interval, 1.16-1.87).

Conclusion: In this nationally representative study, nearly half of injured patients had one or more HRSNs. Greater numbers of HRSNs were associated with worse health outcomes, delayed care, and low-value care. As national screening for HRSNs is implemented, strategies to address these factors are needed and may serve to optimize health and health care utilization among injury survivors.

Level of evidence: Prognostic and Epidemiological; Level III.

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成人伤害幸存者健康相关社会需求的全国分析。

背景：尽管创伤护理取得了进展，但健康的社会决定因素的影响仍然是实现最佳健康结果的障碍。健康相关的社会需求（HRSNs），现在是医疗保险和医疗补助服务中心国家筛查项目的基础，可能会导致不良的健康结果、不公平和低价值的护理，但在国家层面上，HRSNs对受伤患者的影响仍然知之甚少。方法：使用具有全国代表性的2021年医疗支出小组调查数据，通过年龄和性别的粗精确匹配将受伤患者与未受伤对照进行匹配。然后，我们根据医疗保险和医疗补助服务中心确定的核心需求（食品、公用事业、生活状况、交通和个人安全）确定了HRSNs的流行程度。我们使用多变量回归模型来评估HRSNs与健康、护理延误和急诊科就诊之间的关系。结果：总体而言，43%的受伤患者报告了一个或多个HRSNs。与未受伤的对照组相比，受伤患者在所有五个HRSN领域的需求未得到满足的可能性更大(调整后的优势比为1.44-2.00；P < 0.05)。在分层分析中，HRSNs在低收入患者（65.1%）、非西班牙裔黑人患者（61.3%）和医疗补助患者（66.1%）中最高。HRSNs数量的增加与身心健康状况的恶化相关（p < 0.05）。有三个或三个以上HRSNs的受伤患者也更有可能因为成本原因而延迟护理(调整后优势比为3.79；95%可信区间为2.29-6.27)，急诊科使用率较高(调整后发病率比为1.47；95%置信区间为1.16-1.87)。结论：在这项具有全国代表性的研究中，近一半的受伤患者有一个或多个HRSNs。更多的hrsn与更差的健康结果、延迟护理和低价值护理相关。随着HRSNs的国家筛查的实施，需要解决这些因素的战略，并可能有助于优化伤害幸存者的健康和医疗保健利用。证据水平：预后和流行病学；第三层次。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.