Social Determinants Strongly Linked to Onset of Chronic Disease

Posted on: Friday, May 24, 2019 By: KorchekStaff

The social determinants of health were significantly associated with the development of chronic disease.

May 23, 2019 - Individuals’ social determinants of health, including education level, income, diet, and exercise, were strongly associated with the development of a chronic disease, suggesting that providers should assess these factors to identify high-risk patients, according to a studypublished in JAMA Network Open.

Healthcare organizations are increasingly recognizing the critical role social and behavioral factors play in patients’ overall health, the researchers noted.  

“Payment models rewarding good health outcomes rather than simply reimbursing for provision of services have created incentives for practitioners to prevent the onset of disease, slow its progression, and minimize complications,” the group said.

“Recognizing the influence of social and behavioral factors on all three stages, healthcare systems are increasingly screening for social and behavioral factors associated with health.”

Recently, the National Academy of Medicine (NAM) recommended a set of measures that represent social and behavioral factors that impact overall wellness. The team set out to determine whether the NAM social and behavioral factors are linked to the development of diabetes and hypertension during 3.5 years of follow-up.

READ MORE: Kaiser Permanente Gives $20M to Social Determinants Programs


The study included 18,133 people without baseline hypertension and 35,788 people without baseline diabetes.

Overall, 1163 patients, or 6.4 percent, developed hypertension by the end of the follow-up period, ranging from 183 of those with no social or behavioral risk factors to 307 of those with three or more risk factors.

Of those without baseline diabetes, 1442, or four percent, developed diabetes, ranging from 203 patients with no social or behavioral risk factors to 445 patients with three or more risk factors.

The results showed that having less than a high school education level, being widowed, concentrated neighborhood poverty, infrequent exercise, and smoking were significantly associated with hypertension onset.

Having less than a high school education level, financial worry, being single or separated, high stress, concentrated neighborhood poverty, and depressive symptoms were significantly associated with diabetes onset.

READ MORE: AMA, UnitedHealth Partner for Social Determinants ICD-10 Project


Researchers also found that all nonwhite racial and ethnic groups were at higher risk of developing both hypertension and diabetes than white individuals.

Additionally, after conducting sensitivity analyses, the team saw that there was an association between an increasing number of social and behavioral risk factors and increased likelihood of disease.

These results may provide insight for organizations and clinicians looking to screen patients’ social determinants.

“A wide range of healthcare professionals and systems are grappling with whether to screen for social and behavioral risk factors, for which social and behavioral risk factors they should screen, and whom they should screen,” the researchers said.

“Supporting the value of using the NAM measures in a clinical setting, the findings of the current study provide relevant evidence on each of those questions.”

READ MORE: Humana Makes Progress on Social Determinants of Population Health


Regarding whether providers and organizations should screen their patients, researchers said that in samples of patients with no evidence of hypertension or diabetes at baseline, social and behavioral risk factors were associated with disease onset after a relatively short period. The finding suggests that providers can use this information to better target their resources to patients who need tailored care.

The results also support screening for a range of NAM-endorsed social and behavioral risk factors. The team said that because patients with higher overall social and behavioral risk factor scores were at greater risk of disease onset regardless of the specific factors reported, organizations may want to employ broad screening tactics.

As for who should be screened, the researchers noted the findings challenge the notion that screening for social and behavioral risk factors is unnecessary outside safety-net settingsbecause the study sample represented a diverse insured population.

“As more practitioners screen for social and behavioral risk factors, it will be increasingly important to gain consensus on standard measures with evidence-based cut points, which would expedite data sharing across facilities to improve clinical care and facilitate development and evaluation of predictive models,” the team said.

“The adoption of EHRs has permitted access to an ever-expanding amount of data and aided the development of precision medicine. As interventions become increasingly individualized, it will be important to include social and behavioral risk factors in addition to traditional biometric data.”

The researchers noted that their study as limited in that the sample of patients was small and not nationally representative, which could limit the generalizability of the findings.

Still, the team said that their results show that the social determinants of health play a crucial role in patients’ overall health and wellness.

“The current study underscores the potential importance of knowing social and behavioral information in both clinical and healthcare system settings and advocates for exploring the utility of routine collection of this information. There will be logistical challenges to accomplishing this, but our findings support the potential value of doing so,” researchers concluded.