Cumulative Burden of Non-Medical Drivers of Health and Their Associations with Hospital Utilization

Abstract

Background: Vulnerable populations experience multiple adverse non-medical drivers of health (NMDOH) that contribute to poorer health outcomes and increased healthcare utilization. This cross-sectional study examined the associations between NMDOH and hospital-based outcomes in a 2018 Medical-Legal Partnership pilot study.

Methods: Composite scores generated for socio-economic and housing-environmental conditions were categorized to reflect cumulative burden of unmet needs. Logistic regression models examined associations between these scores and the number of ED visits (≥3 visits in the past year) and hospital stays (≥2 days in the past year), controlling for age, sex, race, and income.

Results: In this sample of 174 participants (mean age=52.5 years; 68.2% female; 55% Black, 28% Hispanic; and average monthly income =$1196), 74% were food insecure, 68.3% had ≥2 social and economic needs, and 47.6% reported >1 housing-environmental concern. There were significantly greater odds of ≥3 ED visits (AOR: 7.3; P=0.003) and similarly greater odds of hospital stay of ≥2 days. (AOR: 5.6; P=0.032) among those with ≥4 vs. <4 personal SDOH needs.

Conclusion: Having ≥4 social and economic conditions was strongly associated with poor hospital-related outcomes, indicating the need for a strong response and targeting of the NMDOH that impact healthcare utilization outcomes.

Keywords: Hospital Utilization; Medical-Legal Partnership; Non-medical drivers of health; Vulnerable Populations.