Racial, ethnic, and sex differences in need and receipt of support for social needs among veterans

IMPORTANCE: Health-related social needs, downstream manifestations of social determinants or drivers of health, impact patients' health and well-being. To develop equity-driven social care interventions, health care systems must apply an intersectional equity lens when assessing patients' social needs. 

OBJECTIVE: To evaluate racial, ethnic, and sex differences in social needs and receipt of support among veterans receiving health care in the Veterans Health Administration (VHA). 

DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey study of VHA primary care patients seen in January or February 2023 was carried out in a national sample of veterans, stratified by race and ethnicity (Black, Hispanic, White), and sex (male, female). Participants were invited by mail to complete a survey online or by mail. Of those invited (N = 38 759), 7095 (18.3%) responded. Data collection occurred from March 2, 2023, through May 9, 2023. Analyses were conducted from February 15, 2024, through July 16, 2024. 

EXPOSURES: Intersection of self-identified race, ethnicity, and sex. 

MAIN OUTCOMES AND MEASURES: Age-adjusted prevalence ratio (aPR) of reported need for and receipt of support across 13 social need domains. 

RESULTS: Analyses included 6611 respondents representing 939 467 veterans (unweighted No. of participants [weighted %]; 1089 [4.1%] Black women; 1144 [19.4%] Black men; 941 [1.6%] Hispanic women; 1281 [11.3%] Hispanic men; 805 [5.3%] White women; 1351 [58.4%] White men). After age adjustment, compared with White men, Black men had significantly higher aPRs of need for support in all domains except childcare and employment (aPRs ranged from 1.35 [95% CI, 1.09-1.69] for social isolation to 2.73 [95% CI, 1.89-3.95] for managing discrimination). Hispanic women had higher aPRs in 8 domains: childcare (aPR, 2.78; 95% CI, 1.19-6.48), discrimination (aPR, 2.69; 95% CI, 1.68-4.29), internet (aPR, 1.81; 95% CI, 1.17-2.79), housing (aPR, 1.81; 95% CI, 1.10-2.99), legal issues (aPR, 1.70; 95% CI, 1.02-2.84), loneliness (aPR, 1.67; 95% CI, 1.28-2.18), food (aPR, 1.55; 95% CI, 1.03-2.35), and social isolation (aPR, 1.40; 95% CI, 1.05-1.87). Black women had higher aPRs for discrimination (aPR, 2.68; 95% CI, 1.82-3.95), legal issues (aPR, 2.04; 95% CI, 1.40-2.97), food (aPR, 1.74; 95% CI, 1.28-2.37), loneliness (aPR, 1.60; 95% CI, 1.28-2.01), paying for basics (aPR, 1.57; 95% CI, 1.15-2.14), and social isolation (aPR, 1.48; 95% CI, 1.18-1.87). Hispanic men had higher aPRs for housing (aPR, 1.88; 95% CI, 1.18-3.02), legal issues (aPR, 1.81; 95% CI, 1.14-2.86), internet (aPR, 1.56; 95% CI, 1.13-2.16), and loneliness (aPR, 1.44; 95% CI, 1.10-1.88). White women had higher aPRs for childcare (aPR, 3.37; 95% CI, 1.36-8.35) and discrimination (aPR, 1.60; 95% CI, 1.03-2.50). There was 1 significant difference in receiving support: Black women had a lower prevalence of receiving support for work (aPR, 0.58; 95% CI, 0.35-0.94). 

CONCLUSIONS AND RELEVANCE: This study found that there was wide variation in the health-related social need domains in which VHA race, ethnicity, and sex subpopulations reported needing support. Applying an intersectional lens when evaluating social needs lays the groundwork for equity-guided social care interventions in the VHA.