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Assessing area-level deprivation as a proxy for individual-level social risks

Brown EM, Franklin SM, Ryan JL, et al
Am J Prev Med

Introduction: Concerns about the opportunity costs of social screening initiatives have led some healthcare organizations to consider using social deprivation indices (area-level social risks) as proxies for self-reported needs (individual-level social risks). Yet, little is known about the effectiveness of such substitutions across different populations.

Methods: This analysis explores how well the highest quartile (cold spot) of three different area-level social risk measures-the Social Deprivation Index, Area Deprivation Index, and Neighborhood Stress Score-corresponds with six individual-level social risks and three risk combinations among a national sample of Medicare Advantage members (N=77,503). Data were derived from area-level measures and cross-sectional survey data collected between October 2019 and February 2020. Agreement between individual and individual-level social risks, sensitivity values, specificity values, positive predictive values, and negative predictive values was calculated for all measures in summer/fall 2022.

Results: Agreement between area and individual-level social risks ranged from 53% to 77%. Sensitivity for each risk and risk category never exceeded 42%; specificity values ranged from 62% to 87%. Positive predictive values ranged from 8% to 70%, and negative predictive values ranged from 48% to 93%. There were modest performance discrepancies across area-level measures.

Conclusions: These findings provide additional evidence that area-level deprivation indices may be inconsistent indicators of individual-level social risks, supporting policy efforts to promote individual-level social screening programs in healthcare settings.

Brown EM, Franklin SM, Ryan JL, et al. Assessing Area-Level Deprivation as a Proxy for Individual-Level Social Risks. Am J Prev Med. 2023;65(6):1163-1171. doi:10.1016/j.amepre.2023.06.006

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Publication year
Resource type
Peer Reviewed Research
Outcomes
Social Needs/ SDH
Social Determinant of Health
Economic Security
Food/Hunger
Housing Stability
Transportation
Utilities
Study design
Other Study Design