Differences between individual social risks, social needs, and community-level social risk among pediatric patients

OBJECTIVE: We sought to explore relationships between community-level social determinants of health (SDOH), individual-level social risk factors, and individual-level social needs - whether families desire help addressing social risk factors - among children's families in a large, diverse patient population in the Pacific Northwest. 

METHODS: We conducted a retrospective cohort study of children ages 0-18 who received care at Kaiser Permanente Northwest, an integrated healthcare system serving patients in Oregon and Southwest Washington, between December 1, 2017 - December 31, 2019. Social data came from the Your Current Life Situation survey as recorded in patient electronic medical records, and included information on housing instability, food insecurity, transportation needs, and financial hardships. We used Chi-squared tests to compare rates of social risks, social needs, and NDI quartiles. 

RESULTS: The sample included 2,313 children. Among the 59.6% of families endorsing at least one social risk, 66.9% desired assistance addressing at least one social need. Both individual-level social risks and social needs varied significantly by NDI quartile, with the highest social risk and social needs rates being in the highest NDI quartiles (most social disadvantage). However, among families in the lowest NDI quartile (most social advantage), 42.1% of families endorsed at least one risk and 23.3% of families endorsed at least one social need. 

CONCLUSIONS: In a diverse sample of pediatric patients, we found that a community-level SDOH index inadequately identified families endorsing social risks and social needs. Our findings support policies that incentivize individual-level social risk and social need data collection in clinical settings.