People who have difficulty paying for food and medications are associated with a higher likelihood of having poorer control over their diabetes, according to a new study examining the relationship between nonmedical determinants and health outcomes.
About 39% of patients studied reported to have at least one material need, such as food insecurity, unstable housing and underuse of medications due to cost, according to the study published Monday in JAMA Internal Medicine.
Researchers found such social determinants were associated with poorer management of diabetes and an increased number of outpatient visits, hospitalizations and trips to the emergency department.
“Healthcare systems are increasingly accountable for health outcomes that have roots outside of clinical care,” the study concluded. “Because of this development, strategies that increase access to healthcare resources might reasonably be coupled with those that address social determinants of health, including material need insecurities. In particular, food insecurity and cost-related medication underuse may be promising targets for real-world management of diabetes mellitus.”
Data was collected from a random group of 411 patients from the Boston area with Type 2 diabetes from June 2012 through October 2013. Roughly 46% of those studied were found to have poor diabetes control despite only 4% being uninsured and 3% having no coverage for prescriptions. Roughly 19% of patients reported having food insecurity, while 28% reported underusing medications because of cost. A little more than 10% reported having unstable housing and 14% had issues paying their utility bills.
So, having increased access to healthcare services as has been provided through the Patient Protection and Affordable Care Act may be insufficient to improve health outcomes unless nonmedical factors such as poverty are also addressed, the study concluded.
Hospitals over the last several years have begun to recognize the relationship between social determinants and chronic disease management. Several have taken active steps toward addressing social factors such as poverty, unemployment, housing and safety in an effort to reduce utilization of medical services and health costs.
In November the Institute of Medicine released a report calling for physicians to collect information about patients' behavior and social environment within their electronic health records.
Social determinants have been associated with an increase in certain risk factors, such as smoking, stress and obesity. Those risk factors make it more difficult to manage chronic conditions such as diabetes, which affects about 29 million Americans. An analysis by the Robert Wood Johnson Foundation and Trust for America's Health released in September found obesity—a major risk factor for the onset of Type 2 diabetes—affected low-income Americans at a greater rate than more affluent groups. More than 33% of adults earning less than $15,000 annually were obese, compared with 25% of those making more than $50,000 a year, it found.
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