JMIR Publications

ABSTRACT

Background:

Previous examination of the effects of Social Determinants of Health (SDOH) on population health outcomes in the US is either at the county level or at the state level. Data captured at a lower administrative level is desired for local policy makers to make health policy decisions. Yet, no study has investigated the phenomenon at the city and Census Tract level.

Objective:

This study aims to investigate the relationship between SDOH risk factors and population health outcomes at the city level to support local policy makers to improve population health, enhance quality of care, and reduce health inequity.

Methods:

This study was conducted based on 29,127 Census Tracts in 499 cities across all 50 states in the US. The cities were further grouped into five categories based on population density and political affiliation. A linear mixed effects model was then applied to account for the fixed effect and random effects.

Results:

At the city level, the total variance explained by both fixed and random effects is high, ranging from 0.86 to 0.90. Effect size of variables are different across groups. Asthma, Kidney Disease, Smoking, and Food Stamps variables are significant in all groups at p<0.01 or p<0.001 level.

Conclusions:

We found that population density and political affiliation provided a good segmentation for SDOH and health outcomes research. Furthermore, we identified SDOH has varied effects on health outcomes between different city groups. Likewise, SDOH has similar effects on health outcomes within city groups. Population density and political leaning are an effective delineation for separating how SDOH affects health outcomes.