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. 2025 May 1;32(5):866-875.
doi: 10.1093/jamia/ocae238.

Unmet social needs and diverticulitis: a phenotyping algorithm and cross-sectional analysis

Thomas E Ueland  1 , Samuel A Younan  2 , Parker T Evans  3   4 , Jessica Sims  1 , Megan M Shroder  2 , Alexander T Hawkins  2 , Richard Peek  5 , Xinnan Niu  3 , Lisa Bastarache  3 , Jamie R Robinson  3   4
Affiliations

Unmet social needs and diverticulitis: a phenotyping algorithm and cross-sectional analysis

Thomas E Ueland et al. J Am Med Inform Assoc. .

Abstract

Objective: To validate a phenotyping algorithm for gradations of diverticular disease severity and investigate relationships between unmet social needs and disease severity.

Materials and methods: An algorithm was designed in the All of Us Research Program to identify diverticulosis, mild diverticulitis, and operative or recurrent diverticulitis requiring multiple inpatient admissions. This was validated in an independent institution and applied to a cohort in the All of Us Research Program. Distributions of individual-level social barriers were compared across quintiles of an area-level index through fold enrichment of the barrier in the fifth (most deprived) quintile relative to the first (least deprived) quintile. Social needs of food insecurity, housing instability, and care access were included in logistic regression to assess association with disease severity.

Results: Across disease severity groups, the phenotyping algorithm had positive predictive values ranging from 0.87 to 0.97 and negative predictive values ranging from 0.97 to 0.99. Unmet social needs were variably distributed when comparing the most to the least deprived quintile of the area-level deprivation index (fold enrichment ranging from 0.53 to 15). Relative to a reference of diverticulosis, an unmet social need was associated with greater odds of operative or recurrent inpatient diverticulitis (OR [95% CI] 1.61 [1.19-2.17]).

Discussion: Understanding the landscape of social barriers in disease-specific cohorts may facilitate a targeted approach when addressing these needs in clinical settings.

Conclusion: Using a validated phenotyping algorithm for diverticular disease severity, unmet social needs were found to be associated with greater severity of diverticulitis presentation.

Keywords: diverticular disease; phenotyping algorithm; social determinants of health.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1.
Figure 1.
Sub-phenotyping algorithm for diverticular disease severity.
Figure 2.
Figure 2.
Distribution of individual-level social variables across area-level Brokamp Deprivation Index quintiles. (A) Heatmap demonstrating the proportion of social barriers within each deprivation index quintile. (B) Fold enrichment of the proportion of social barriers in the fifth (most deprived) quintile relative to first (least deprived) quintile. A top box score is achieved only with the most favorable responses to each survey question, while all other combinations of responses are assigned a non-top box score. Edu = education; VS = hunger vital sign; HS = high school; Ins = insurance; BHLS = brief health literacy screen; NDS = Ross-Mirowsky perceived neighborhood physical disorder subscale; MOS-SS = modified medical outcome study social support survey.
Figure 3.
Figure 3.
Logistic regression model for Operative or Recurrent Inpatient diverticulitis. Model covariates were age, sex at birth, BMI, Charlson Comorbidity Index, binary unmet social need variable, insurance, highest education, annual income, and interaction terms between education and unmet social need as well as income and unmet social need. OR = odds ratio; CI = confidence interval; CDR = curated data repository cutoff date; BMI = body mass index (kg/m2); CCI: Charlson comorbidity index; HS = high school.
Figure 4.
Figure 4.
Public reporting summary.
See this image and copyright information in PMC

References

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