Table 2. Association Between Individual Health-Related Social Needs (HRSNs) and Rates of Hospital Stays and Emergency Department (ED) Visits.
| HRSN | Marginal effect of HRSN on rates of utilization per 1000 beneficiaries (95% CI)a | |||
|---|---|---|---|---|
| Hospital stays | ED visits | |||
| All causeb | Avoidablec | All cause | Avoidabled | |
| Food insecurity | 11.9 (−2.9 to 26.7) | 2.0 (−4.1 to 8.2) | 50.9 (29.6 to 72.2)e | 20.8 (9.0 to 32.6)e |
| Financial strain | 26.5 (14.2 to 38.9)e | 14.7 (9.4 to 20.4)e | 37.6 (20.5 to 54.8)e | 18.6 (8.9 to 28.3)e |
| Loneliness | 7.1 (−13.7 to 27.9) | 1.8 (−6.9 to 10.5) | 80.6 (46.9 to 114.3)e | 44.4 (25.1 to 63.8)e |
| Unreliable transportation | 51.2 (30.7 to 71.8)e | 10.9 (2.2 to 19.5)e | 95.5 (65.3 to 125.8)e | 26.8 (10.9 to 42.6)e |
| Utility insecurity | −6.5 (−23.0 to 10.0) | −0.4 (−7.4 to 6.7) | 11.6 (−12.1 to 35.3) | 6.0 (−7.3 to 19.3) |
| Housing insecurity | 17.2 (−4.2 to 38.7) | 3.8 (−5.3 to 12.9) | 44.6 (13.7 to 75.6)e | 7.1 (−9.3 to 23.6) |
| Poor housing quality | −7.3 (−20.2 to 5.7) | 1.6 (−4.2 to 7.3) | 20.4 (1.8 to 39.1)e | 17.2 (6.5 to 27.8)e |
Calculated from negative binomial regression models estimating the association between individual HRSNs and utilization measures. Models adjust for age, sex, race and ethnicity, disability status, dual eligibility status, Elixhauser Comorbidity Index score, and all other individual HRSNs, with hospital referral region fixed effects. The reference group for all marginal effects is beneficiaries not reporting that specific HRSN.
Hospital stays are an aggregate of inpatient admissions and observation stays.
Avoidable hospital stays were defined using the Agency for Healthcare Research and Quality Prevention Quality Indicators definition.20
Avoidable ED visits were defined using the New York University ED visit algorithm and subsequent algorithm patch.21,22
Statistical significance at the P < .05 level.