Background: Evidence shows that social risks are highly prevalent in the patient population that presents to the emergency department (ED) for care; however, understanding the relationship between social risk factors and ED utilization at the population level remains unknown. Methods: We used the National Health Interview Survey from the 2016–2018 sample adult files. The sample included 82,364 individuals, representing a population size of 238,888,238. The primary independent variables included six social risk factors: economic instability; lack of community; educational deficit; food insecurity; social isolation; and inadequate access to care. The outcome included ED use in the prior year. Covariates included age, race/ethnicity, insurance status, obesity, mental health (depression/anxiety), and comorbidities. We ran logistic regression models to test the relationship between the independent and dependent variables adjusting for covariates. Results: In the study sample, 20% had at least one ED visit in the prior year. In the fully adjusted model, individuals reporting economic instability (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.25-1.42), lack of community (OR 1.10, 95% CI 1.05-1.15), educational deficit (OR 1.12, 95% CI 1.06-1.18), food insecurity (OR 1.77, 95% CI 1.66-1.89), and social isolation (OR 1.32, 95% CI 1.26-1.39) had significantly higher odds of ED use. Inadequate access to care was significantly related to lower odds of ED use (OR 0.75, 95% CI 0.69-0.81). Conclusions: Social risk factors are significantly associated with higher odds of ED use in the United States adult population. Interventions that integrate social and medical needs are greatly needed, as is understanding the role that preventive medicine may play in reducing avoidable ED visits.

Background: This study aimed to investigate the relationship between food insecurity and physical- and mental-health-related quality of life in adults with diabetes. Methods: Using two years of national Medical Expenditure Panel Survey data (2016–2017), we investigated the relationship between food insecurity and physical-health-related (PCS) and mental-health-related (MCS) quality of life in adults with diabetes. PCS and MCS were measured with the Short-Form 12 health survey and food insecurity was measured with the USDA 10-item adult scale. Analyses were weighted to represent the US adult population. Adjusted linear regression models, including covariates of age, gender, education, race/ethnicity, marital status, region, poverty level, employment status, health insurance, and comorbidities were used. Results: After adjustment, food-insecure adults with diabetes maintained significantly lower quality of life compared to food-secure adults with diabetes (PCS: −3.44, 95%CI −4.63, −2.25; MCS: −5.37, 95%CI −6.68, −4.06). This drop in PCS was larger than the drop for chronic conditions, including arthritis (−3.77, 95%CI −5.02, −2.52), emphysema (−2.82, 95%CI −5.12, −0.53), stroke (−2.63, 95%CI −4.11, −1.15), cancer (−2.59, 95%CI −4.00, −1.17), and heart attack (2.58, 95%CI 4.68, 0.48). Similarly, the drop for MCS was larger than for chronic pain (−2.37, 95%CI −3.24, −1.50) and arthritis (−1.31, 95%CI −2.28, −0.33). Conclusions: Food insecurity was associated with a significant reduction in both physical- and mental-health-related quality of life in adults with diabetes, with a magnitude of effect greater than adjusted estimates for the drop in quality of life for key chronic conditions. Addressing food insecurity through integration of social and medical care may lead to improvements in quality of life for adults with diabetes.

Racial/ethnic and sex concordance between patients and providers has been suggested as an important consideration in improving satisfaction and increasing health equity. We aimed to guide local efforts by understanding the relationship between satisfaction with care and patient–provider racial/ethnic and sex concordance within our academic medical center’s primary care clinic. Methods: Satisfaction data for encounters from August 2016 to August 2019 were matched to data from the medical record for patient demographics and comorbidities. Data on 33 providers were also obtained, and racial/ethnic and sex concordance between patients and providers was determined for each of the 3672 unique encounters. The primary outcome was top-box scoring on the CGCAHPS overall satisfaction scale (0–8 vs. 9–10). Generalized mixed-effects logistic regression, including provider- and patient-level factors as fixed effects and a random intercept effect for providers, were used to determine whether concordance had an independent relationship with satisfaction. Results: 89.0% of the NHW-concordant pairs and 90.4% of the Minority Race/Ethnicity-concordant pairs indicated satisfaction, while 90.1% of the male-concordant and 85.1% of the female-concordant pairs indicated satisfaction. When fully adjusted, the female-concordant (OR = 0.58, 95% CI 0.35–0.94) and male-discordant (OR = 0.68, 95% CI 0.51–0.91) pairs reported significantly lower top-box satisfaction compared to the male-concordant pairs. Significant differences did not exist in racial/ethnic concordance. Conclusions: In this sample, differences in sex concordance were noted; however, patient- and provider-level factors may be more influential in driving patient satisfaction than race/ethnicity in this health system.