The Impact of Social Determinants of Health on Hospitalization in the Veterans Health Administration

Elham Hatef, Kelly M. Searle, Zachary Predmore, Elyse Lasser, Hadi H K Kharrazi, Karin Nelson, Philip Sylling, Idamay Curtis, Stephan D. Fihn, Jonathan Weiner

Research output: Contribution to journalArticle

Abstract

Introduction: This study aims to assess the effect of individual and geographic-level social determinants of health on risk of hospitalization in the Veterans Health Administration primary care clinics known as the Patient Aligned Care Team. Methods: For a population of Veterans enrolled in the primary care clinics, the study team extracted patient-level characteristics and healthcare utilization records from 2015 Veterans Health Administration electronic health record data. They also collected census data on social determinants of health factors for all U.S. census tracts. They used generalized estimating equation modeling and a spatial-based GIS analysis to assess the role of key social determinants of health on hospitalization. Data analysis was completed in 2018. Results: A total of 6.63% of the Veterans Health Administration population was hospitalized during 2015. Most of the hospitalized patients were male (93.40%) and white (68.80%); the mean age was 64.5 years. In the generalized estimating equation model, white Veterans had a 15% decreased odds of hospitalization compared with non-white Veterans. After controlling for patient-level characteristics, Veterans residing in census tracts with the higher neighborhood SES index experienced decreased odds of hospitalization. A spatial-based analysis presented variations in the hospitalization rate across the Veterans Health Administration primary care clinics and identified the clinic sites with an elevated risk of hospitalization (hotspots) compared with other clinics across the country. Conclusions: By linking patient and population-level data at a geographic level, social determinants of health assessments can help with designing population health interventions and identifying features leading to potentially unnecessary hospitalization in selected geographic areas that appear to be outliers.

Original languageEnglish (US)
JournalAmerican journal of preventive medicine
DOIs
StatePublished - Jan 1 2019

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Social Determinants of Health
Veterans Health
United States Department of Veterans Affairs
Hospitalization
Veterans
Censuses
Primary Health Care
Population
Patient Care Team
Spatial Analysis
Electronic Health Records
Delivery of Health Care
Health

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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The Impact of Social Determinants of Health on Hospitalization in the Veterans Health Administration. / Hatef, Elham; Searle, Kelly M.; Predmore, Zachary; Lasser, Elyse; Kharrazi, Hadi H K; Nelson, Karin; Sylling, Philip; Curtis, Idamay; Fihn, Stephan D.; Weiner, Jonathan.

In: American journal of preventive medicine, 01.01.2019.

Research output: Contribution to journalArticle

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