Intersecting social determinants of health among patients with childcare needs: a cross-sectional analysis of social vulnerability.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Social Determinants of Health* ; Ethnicity*; Child ; Humans ; Cross-Sectional Studies ; Social Vulnerability ; Child Care ; Minority Groups

Introduction: Access to childcare is an understudied social determinant of health (SDOH). Our health system established a childcare facility for patients to address childcare barriers to healthcare. Recognizing that social risk factors often co-exist, we sought to understand intersecting social risk factors among patients with childcare needs who utilized and did not utilize the childcare facility and identify residual unmet social needs alongside childcare needs.
Methods: We conducted a cross-sectional analysis of patients who enrolled in the childcare facility from November 2020 to October 2022 to compare parameters of the Social Vulnerability Index (SVI) associated with the census tract extracted from electronic medical record (EMR) data among utilizers and non-utilizers of the facility. Overall SVI and segmentation into four themes of vulnerability (socioeconomic status, household characteristics, racial/ethnic minority status, and housing type/transportation) were compared across utilizers and utilizers. Number of 90th percentile indicators were also compared to assess extreme levels of vulnerability. A sample of utilizers additionally received a patient-reported social needs screening questionnaire administered at the childcare facility.
Results: Among 400 enrollees in the childcare facility, 70% utilized childcare services and 30% did not. Utilizers and non-utilizers were demographically similar, though utilizers were more likely to speak Spanish (34%) compared to non-utilizers (22%). Mean SVI was similar among utilizers and non-utilizers, but the mean number of 90th percentile indicators were higher for non-utilizers compared to utilizers (4.3 ± 2.7 vs 3.7 ± 2.7, p = 0.03), primarily driven by differences in the housing type/transportation theme (p = 0.01). Non-utilizers had a lower rate of healthcare utilization compared to utilizers (p = 0.02). Among utilizers who received patient-reported screening, 84% had one unmet social need identified, of whom 62% agreed for additional assistance. Among social work referrals, 44% were linked to social workers in their medical clinics, while 56% were supported by social work integrated in the childcare facility.
Conclusions: This analysis of SDOH approximated by SVI showed actionable differences, potentially transportation barriers, among patients with childcare needs who utilized a health system-integrated childcare facility and patients who did not utilize services. Furthermore, residual unmet social needs among patients who utilized the facility demonstrate the multifactorial nature of social risk factors experienced by patients with childcare needs and opportunities to address intersecting social needs within an integrated intervention. Intersecting social needs require holistic examination and multifaceted interventions.
(© 2024. The Author(s).)

Surgery. 2020 Nov;168(5):868-875. (PMID: 32800602)
Soc Work Public Health. 2014;29(6):629-39. (PMID: 25144703)
JAMA Health Forum. 2021 Aug 6;2(8):e212001. (PMID: 35977189)
Soc Sci Res. 2015 Mar;50:292-302. (PMID: 25592937)
Ethn Dis. 2021 Jan 21;31(1):9-22. (PMID: 33519151)
J Gen Intern Med. 2018 Jun;33(6):863-868. (PMID: 29380214)
Health Promot Chronic Dis Prev Can. 2021 Jan;41(1):1-13. (PMID: 33439566)
Qual Health Res. 2013 Apr;23(4):476-94. (PMID: 23427078)
Int J Disaster Risk Reduct. 2020 Jun;46:. (PMID: 35923219)
Am J Prev Med. 2020 Sep;59(3):317-325. (PMID: 32703701)
Circ Cardiovasc Qual Outcomes. 2022 Jan;15(1):e007917. (PMID: 35041484)
J Womens Health (Larchmt). 2020 Nov;29(11):1437-1446. (PMID: 32366199)
Am J Drug Alcohol Abuse. 2017 Jul;43(4):475-488. (PMID: 28375656)
J Emerg Med. 2015 Nov;49(5):755-62.e2. (PMID: 26281811)
JAMA Netw Open. 2020 Oct 1;3(10):e2016852. (PMID: 33119102)
Soc Sci Med. 2015 Dec;147:121-5. (PMID: 26560411)
Matern Child Health J. 2019 Nov;23(11):1516-1524. (PMID: 31228149)
J Am Board Fam Med. 2010 Jan-Feb;23(1):13-21. (PMID: 20051538)
Med Care. 2017 Sep;55(9):817-822. (PMID: 28731892)
BMJ Open Qual. 2022 Oct;11(4):. (PMID: 36261213)
Am J Epidemiol. 1988 May;127(5):893-904. (PMID: 3282433)
Health Soc Care Community. 2019 Jul;27(4):953-964. (PMID: 30637811)
Perm J. 2018 Sep 13;22:18-078. (PMID: 30227912)
Health Policy. 2009 Jun;91(1):24-32. (PMID: 19070930)
Annu Rev Public Health. 2004;25:397-418. (PMID: 15015927)
JAMA Intern Med. 2018 Mar 1;178(3):383-389. (PMID: 29404572)
J Community Health. 2019 Apr;44(2):400-411. (PMID: 30206755)
N Engl J Med. 2020 Sep 17;383(12):e77. (PMID: 32706952)
Health Place. 2005 Jun;11(2):131-46. (PMID: 15629681)
J Health Care Poor Underserved. 2009 Aug;20(3):840-5. (PMID: 19648710)
JAMA. 2020 Apr 28;323(16):1553-1554. (PMID: 32242887)
Ann Anthropol Pract. 2017 Nov;41(2):67-77. (PMID: 30233917)
Health Aff (Millwood). 2016 Aug 1;35(8):1416-23. (PMID: 27503966)
Am J Med Sci. 2016 Apr;351(4):366-73. (PMID: 27079342)

Keywords: Childcare; Geospatial analysis; Intervention; Social determinants of health; Social vulnerability index

Date Created: 20240229 Date Completed: 20240304 Latest Revision: 20240304

20240304

PMC10902938

10.1186/s12889-024-18168-8

38424507