Racial-ethnic differences in prevalence of social determinants of health and social risks among middle-aged and older adults in a Northern California health plan

Abstract

Background: Social determinants of health (SDoHs) and social risks (SRs) have been associated with adverse health and healthcare utilization and racial/ethnic disparities. However, there is limited information about the prevalence of SRs in non-"safety net" adult populations and how SRs differ by race/ethnicity, age, education, and income.

Methods: We analyzed weighted survey data for 16,247 White, 1861 Black, 2895 Latino, 1554 Filipino, and 1289 Chinese adults aged 35 to 79 who responded to the 2011 or 2014/2015 Kaiser Permanente Northern California Member Health Survey. We compared age-standardized prevalence estimates of SDoHs (education, household income, marital status) and SRs (financial worry, cost-related reduced medication use and fruit/vegetable consumption, chronic stress, harassment/discrimination, health-related beliefs) across racial/ethnic groups for ages 35 to 64 and 65 to 79.

Results: SDoHs and SRs differed by race/ethnicity and age group, and SRs differed by levels of education and income. In both age groups, Blacks, Latinos, and Filipinos were more likely than Whites to be in the lower income category and be worried about their financial situation. Compared to Whites, cost-related reduced medication use was higher among Blacks, and cost-related reduced fruit/vegetable consumption was higher among Blacks and Latinos. Younger adults were more likely than older adults to experience chronic stress and financial worry. Racial/ethnic disparities in income were observed within similar levels of education. Differences in prevalence of SRs by levels of education and income were wider within than across racial/ethnic groups.

Conclusions: In this non-"safety net" adult health plan population, Blacks, Latinos, and Filipinos had a higher prevalence of social risks than Whites and Chinese, and prevalence of social risks differed by age group. Our results support the assessment and EHR documentation of SDoHs and social risks and use of this information to understand and address drivers of racial/ethnic disparities in health and healthcare use.

Fig 1. Percentages of adults in lower and higher income categories by educational attainment, race/ethnicity and age group.

All percentages are age-sex standardized. All differences between lower and higher levels of education within racial/ethnic groups are statistically significant at p<.05.

Fig 2. Percentages of adults at lower and high levels of education who believe that their health habits/lifestyle can have a large effect on their health, by race/ethnicity and age group.

All percentages are age-sex standardized. All differences between lower and higher levels of education within racial/ethnic groups are statistically significant at p<.05.

Fig 3. Percentages of adults in lower and higher income categories who worried a great deal about their financial situation by race/ethnicity and age group.

Lower income:<$35,000 for both age groups; Higher income: ≥ $100,000 for ages 35–64 and ≥ $65,000 for ages 65–79. All percentages are age-sex standardized. All differences between lower and higher income groups within racial/ethnic groups for ages 35–64 and within White, Black, Latino, and Filipino groups for ages 65–79 are statistically significant at p<.05.

Fig 4. Percentages of adults in lower and higher income categories who in the past year used less medication than prescribed due to cost, by race/ethnicity and age group.

Lower income:<$35,000; Higher income: ≥ $100,000 for ages 35–64 and ≥ $65,000 for ages 65–79. All percentages are age-sex standardized. All differences between lower and higher income groups within race/ethnicity for the 35–64 age group and for Whites, Blacks, and Latinos in the 65–79 age group are statistically significant at p<.05.

Fig 5. Percentages of adults in lower and higher income categories who in the past year ate less fruits and vegetables than wanted to due to cost, by race/ethnicity and age group.

Lower income:<$35,000; Higher income: ≥ $100,000 for ages 35–64 and ≥ $65,000 for ages 65–79. All percentages are age-sex standardized. Differences between lower and higher income groups for Whites, Blacks, Latinos, and Chinese in the 35–64 age group and for Whites, Blacks, and Latinos in the 65–79 age group are statistically significant at p<.05.