Table 1.
Adults With T2DM in CHCs That Screen for Social Risks (July 2016‒February 2020)
| Characteristics | All, column % | SDH risk screening documentation group, row % | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Food insecurity | Housing insecurity | Transportation insecurity | ||||||||
| Documented | Documented | Documented | ||||||||
| Need | No need | Not documented | Need | No need | Not documented | Need | No need | Not documented | ||
| Patients, n | 73,484 | 3,283 | 6,620 | 63,581 | 1,554 | 7,876 | 64,054 | 1,625 | 6,341 | 65,518 |
| Female, % | 56.3 | 4.7 | 8.9 | 86.4 | 2.1 | 11.1 | 86.8 | 2.3 | 8.9 | 88.8 |
| Race and ethnicity, % | ||||||||||
| Hispanic | 36.3 | 3.1 | 5.5 | 91.3 | 1.1 | 5.7 | 93.2 | 1.2 | 4.9 | 93.8 |
| Non-Hispanic Black | 20.4 | 6.6 | 12.3 | 81.1 | 3.7 | 19.5 | 76.9 | 3.4 | 14.0 | 82.6 |
| Non-Hispanic White | 31.6 | 4.9 | 9.2 | 85.9 | 2.4 | 8.8 | 88.8 | 2.6 | 7.6 | 89.8 |
| Non-Hispanic other | 7.2 | 3.7 | 12.8 | 83.4 | 1.6 | 15.4 | 83.0 | 2.4 | 13.1 | 84.5 |
| No data | 4.4 | 4.0 | 14.7 | 81.3 | 2.4 | 17.6 | 80.0 | 1.9 | 14.1 | 84.0 |
| Preferred language, % | ||||||||||
| English | 60.1 | 5.4 | 9.5 | 85.0 | 2.7 | 11.2 | 86.1 | 2.8 | 9.3 | 87.9 |
| Non-English | 39.9 | 3.0 | 8.2 | 88.8 | 1.2 | 10.0 | 88.8 | 1.3 | 7.7 | 91.0 |
| Age at index encounter | ||||||||||
| Median (range) | 58 (18, 103) | 57 (18, 92) | 60 (18, 99) | 58 (18,103) | 57 (18, 98) | 61 (18, 99) | 58 (18, 103) | 57 (18, 92) | 60 (18, 98) | 58 (18, 103) |
| Group, years, % | ||||||||||
| 18–39 | 9.0 | 4.3 | 7.2 | 88.6 | 2.0 | 8.2 | 89.8 | 1.9 | 6.6 | 91.5 |
| 40–64 | 61.7 | 5.0 | 8.1 | 86.9 | 2.4 | 9.6 | 88.0 | 2.5 | 7.9 | 89.6 |
| ≥65 | 29.3 | 3.5 | 11.4 | 85.1 | 1.6 | 13.8 | 84.6 | 1.7 | 10.8 | 87.6 |
| Payer at index encounter, % | ||||||||||
| Medicaid | 36.5 | 5.3 | 7.6 | 87.1 | 2.6 | 9.7 | 87.6 | 2.9 | 7.8 | 89.3 |
| Medicare | 32.7 | 4.6 | 10.0 | 85.4 | 2.1 | 12.1 | 85.9 | 2.2 | 9.8 | 87.9 |
| Other public | 6.1 | 1.4 | 4.1 | 94.5 | 0.5 | 5.5 | 94.0 | 0.7 | 4.1 | 95.2 |
| Private | 14.1 | 3.4 | 14.5 | 82.1 | 1.7 | 17.3 | 81.0 | 1.4 | 13.6 | 85.0 |
| Uninsured | 10.6 | 4.3 | 6.3 | 89.4 | 1.9 | 4.2 | 93.9 | 1.9 | 3.9 | 94.3 |
| Federal poverty level, % | ||||||||||
| >200% | 8.3 | 3.0 | 12.9 | 84.1 | 1.5 | 10.6 | 87.9 | 1.3 | 9.0 | 89.7 |
| ≤200% | 78.9 | 4.7 | 7.9 | 87.4 | 2.2 | 9.8 | 88.0 | 2.4 | 7.6 | 90.0 |
| No data | 12.8 | 4.1 | 13.2 | 82.7 | 1.9 | 16.3 | 81.8 | 1.8 | 14.6 | 83.6 |
| Visits per year, % | ||||||||||
| 1–2 | 16.0 | 3.0 | 7.6 | 89.3 | 1.4 | 8.0 | 90.7 | 1.3 | 6.1 | 92.6 |
| 3–4 | 30.1 | 3.6 | 8.7 | 87.7 | 1.7 | 9.7 | 88.6 | 1.8 | 7.9 | 90.4 |
| 5–6 | 30.0 | 4.7 | 9.5 | 85.8 | 2.3 | 11.7 | 86.0 | 2.3 | 9.6 | 88.1 |
| ≥7 | 23.9 | 6.2 | 9.8 | 84.0 | 2.9 | 12.6 | 84.4 | 3.2 | 10.1 | 86.7 |
| Years of observation,a % | ||||||||||
| (1.2) | 95.3 | 4.5 | 9.1 | 86.5 | 2.1 | 10.8 | 87.1 | 2.2 | 8.7 | 89.0 |
| (2,3.7) | 4.7 | 4.2 | 7.8 | 88.0 | 2.2 | 8.7 | 89.2 | 2.2 | 6.5 | 91.4 |
| Statin medication indicatedb | 73.5 | 4.7 | 8.9 | 86.4 | 2.2 | 10.6 | 87.2 | 2.3 | 8.6 | 89.1 |
Note: These data were representative of 178 clinics spanning 13 U.S. states categorized by regions Midwest (Indiana, Minnesota, Ohio, and Wisconsin), Northeast (Massachusetts), South (Georgia, North Carolina, and Texas), and West (Alaska, California, Montana, Oregon, and Washington). SDH risk group was determined during the observation period. Pearson’s chi-square tests were performed comparing characteristics by whether or not the patient had been screened for the specific SDHs need; all tests were statistically significant at the 0.05 p-value level, except as described below: for food insecurity, sex was not significant, for housing insecurity and transportation insecurity, the statin medication indicated was not significant.
Study duration was determined at the patient level and defined by their last primary care encounter date and their first primary care encounter date that occurred at least 1 year before their last primary care encounter. Primary care encounters were identified using the combination of the level of service CPT codes and practitioner type (MD, PA, NP, and DO).
Statin indication criteria for patients with T2DM who are not pregnant/breastfeeding and who have not been diagnosed with rhabdomyolysis, end-stage renal disease, or renal failure and who are either (1) aged 40−75 years or (2) aged >21 years with atherosclerotic cardiovascular disease or low-density lipoprotein ≥160 mg/dL.
CHC, community health center; CPT, current procedural terminology; DO, doctor of osteopathic medicine; MD, doctor of medicine; NP, nurse practitioner; PA, physician assistant; SDH, social determinant of health; T2DM, type 2 diabetes mellitus.