JMIR Publications

ABSTRACT

Background:

The Social Determinants of Health (SDoH) have a significant impact on the overall health of the population and are critical to our understanding of health conditions, disparities, and how we can improve health outcomes. The COVID-19 pandemic had a profound impact on SDoH and contributed to food and housing insecurity and highlighted weaknesses in the healthcare system surrounding access to health resources for minority and vulnerable populations. People of color as well as Low-income families and those with lower educational attainment experienced greater hardships related to the SDoH than those living in wealthier, white neighborhoods.

Objective:

The research objective of this paper is to determine if a significant difference in SDoH responses exist at the county level before and after the COVID-19 pandemic declaration.

Methods:

A composite score was created for SDOH responses, and a Stuart-Maxwell test was used to compare paired individuals’ responses before and after the COVID-19 pandemic declaration time periods. Additionally, Mcnemar’s tests were used to compare paired individuals’ responses to the individual SDOH questions before and after the COVID-19 pandemic declaration time periods.

Results:

The Stuart-Maxwell test showed there was a significant difference in the SDOH composite score between the two time periods at an alpha level of 0.05. Also, the unadjusted Mcnemar’s tests showed a significant difference between the two time periods for all the questions except question 11 at an alpha level of 0.05.

Conclusions:

Post-COVID-19 responses showed improvement across most questions, a possible indication that government policy response positively impacted the SDoH across the population. Some counties were impacted more than others and positive outcomes were not limited to urban counties and the availability of resources, safety net services, access to healthcare, and educational opportunities could play a role. Future research should focus on rural counties to increase the number of patients responding and other explanatory variables such as food pantry access, educational and employment opportunities, and access to community resources. Government policies should also be an area of focused research as these policies may affect the SDoH factors we considered in this analysis. Clinical Trial: The University of Kansas Medical Center granted approval under a central IRB with reliance by the other institutions (STUDY00148041)