JMIR Publications

ABSTRACT

Background:

The social determinants of health are of growing importance to health care delivery and health policy. Unmet social needs are prevalent and can ultimately exacerbate health conditions, and require significant time and organizational resources to address. Concurrent with growing interest in better addressing patients’ non-medical issues is the exponential growth in availability of data sources that provide insight into the social determinants of health.

Objective:

The purpose of this review was to characterize the state of the existing literature around the use of social determinants of health indicators in conjunction with clinical data.

Methods:

We conducted a rapid review of English-language published articles and relevant agency publications. Eligible studies described the effect of, the methods to, or the need for combining social determinants data with clinical data, and were published in the United States between 2010 to April 2018. Additional reports were obtained by manual searching. Records were screened for inclusion in two rounds by four trained reviewers with inter-rater reliability checks. From each article, we abstracted the measures, data sources, and level of measurement (individual or aggregate) for each social determinant of health reported.

Results:

A total of 178 articles were included for review. The articles collectively reported on 744 different social determinants of health measures. Measures related to socioeconomic status and material conditions were most prevalent (included in 90% of articles), followed by the closely related domain of social circumstances (included in 25% of articles), reflecting the widespread availability and use of standard demographic measures such as household income, marital status, education, and race/ethnicity in public health surveillance. Measures related to health-related behaviors (e.g., smoking, diet, tobacco, substance abuse), the built environment (e.g., transportation, sidewalks, buildings), natural environment (e.g., air quality, pollution), and health services and conditions (e.g., provider of care supply, utilization, disease prevalence/presence) were less common, while measures related to public policies were rare. When combining social determinants and clinical data, a majority of studies associated aggregate, area-level social determinants measures with individual-level clinical data by matching geographical location.

Conclusions:

A variety of social determinants measures have been widely but unevenly used in conjunction with clinical data to support population health research.