Association Between Social and Economic Needs With Future Healthcare Utilization

Published:December 10, 2019DOI:


      Unmet social and economic needs are associated with poor health outcomes, but little is known about how these needs are predictive of future healthcare utilization. This study examined the association of social and economic needs identified during medical visits with future hospitalizations and emergency department visits.


      Individuals with electronic health record–coded social and economic needs during a primary care, emergency department, or urgent care visit at Kaiser Permanente Northwest from October 1, 2016 to November 31, 2017 (case patients) were identified, as well as individuals who had visits during that time period but had no electronic health record–coded needs (control patients). The 2 groups were compared on sociodemographic characteristics, comorbidities, and healthcare utilization in the prior year. Finally, logistic regression assessed the relationship between documented needs and hospitalizations and emergency department visits in the 12 months following the index visit, controlling for sociodemographic characteristics, comorbidities, and prior healthcare utilization. Statistical analysis was completed in April 2019.


      Case patients differed significantly from control patients on sociodemographic characteristics and had higher rates of comorbidities and prior healthcare utilization. Social and economic needs documented during the index visit were associated with significantly higher rates of hospitalization and emergency department visits in the 12 months following the visit, controlling for sociodemographic characteristics, comorbidities, and prior utilization.


      These results demonstrate that documented social and economic needs are a powerful predictor of future hospitalization and emergency department use and suggest the need for research into whether interventions to address these needs can influence healthcare utilization.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Booske B, Athens J, Kindig D, Park H, Remington P. County Health Rankings Working paper. Different Perspectives for Assigning Weights to Determinants of Health. Madison, WI: University of Wisconsin, Population Health Published 2010. Accessed November 8, 2019.

        • Woolf SH
        • Braveman P
        Where health disparities begin: the role of social and economic determinants—and why current policies may make matters worse.
        Health Aff (Millwood). 2011; 30: 1852-1859
        • Krieger J
        • Higgins DL
        Housing and health: time again for public health action.
        Am J Public Health. 2002; 92: 758-768
        • Mansfield C
        • Novick LF
        Poverty and health: focus on North Carolina.
        N C Med J. 2012; 73: 366-373
        • Seligman HK
        • Laraia BA
        • Kushel MB
        Food insecurity is associated with chronic disease among low-income NHANES participants.
        J Nutr. 2010; 140: 304-310
      2. Artiga S, Hinton E. Beyond health care: the role of social determinants in promoting health and health equity. Accessed on November 8, 2019.

        • Gottlieb L
        • Tobey R
        • Cantor J
        • Hessler D
        • Adler NE
        Integrating social and medical data to improve population health: opportunities and barriers.
        Health Aff (Millwood). 2016; 35: 2116-2123
        • Friedman NL
        • Banegas MP.
        Toward addressing social determinants of health: a health care system strategy.
        Perm J. 2018; 22: 18-095
        • Tuliani TA
        • Shenoy M
        • Parikh M
        • Jutzy K
        • Hilliard A
        Impact of area deprivation index on coronary stent utilization in a medicare nationwide cohort.
        Popul Health Manag. 2017; 20: 329-334
        • Kieszak SM
        • Flanders WD
        • Kosinski AS
        • Shipp CC
        • Karp H
        A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data.
        J Clin Epidemiol. 1999; 52: 137-142
        • Deyo RA
        • Cherkin DC
        • Ciol MA
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619