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Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study

BACKGROUND: To address patient’s unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergenc...

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Autores principales: Park, Yoosun, Quinn, James W., Hurvitz, Philip M., Hirsch, Jana A., Goldsmith, Jeff, Neckerman, Kathryn M., Lovasi, Gina S., Rundle, Andrew G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934473/
https://www.ncbi.nlm.nih.gov/pubmed/35305617
http://dx.doi.org/10.1186/s12913-022-07749-1
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author Park, Yoosun
Quinn, James W.
Hurvitz, Philip M.
Hirsch, Jana A.
Goldsmith, Jeff
Neckerman, Kathryn M.
Lovasi, Gina S.
Rundle, Andrew G.
author_facet Park, Yoosun
Quinn, James W.
Hurvitz, Philip M.
Hirsch, Jana A.
Goldsmith, Jeff
Neckerman, Kathryn M.
Lovasi, Gina S.
Rundle, Andrew G.
author_sort Park, Yoosun
collection PubMed
description BACKGROUND: To address patient’s unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergence of disparities in spatial access to social services from 1990 to 2014. METHODS: Social service providers in the lower 48 continental U.S. states were identified annually from 1990 to 2014 from the National Establishment Times Series (NETS) database. The addresses of providers were linked in each year to 2010 US Census tract geometries. Time series analyses of annual counts of services per Km(2) were conducted using Generalized Estimating Equations with tracts stratified into tertiles of 1990 population density, quartiles of 1990 poverty rate and quartiles of 1990 to 2010 change in median household income. RESULTS: Throughout the period, social service agencies/Km(2) increased across tracts. For high population density tracts, in the top quartile of 1990 poverty rate, compared to tracts that experienced the steepest declines in median household income from 1990 to 2010, tracts that experienced the largest increases in income had more services (+ 1.53/Km(2), 95% CI 1.23, 1.83) in 1990 and also experienced the steepest increases in services from 1990 to 2010: a 0.09 services/Km(2)/year greater increase (95% CI 0.07, 0.11). Similar results were observed for high poverty tracts in the middle third of population density, but not in tracts in the lowest third of population density, where there were very few providers. CONCLUSION: From 1990 to 2014 a spatial mismatch emerged between the availability of social services and the expected need for social services as the population characteristics of neighborhoods changed. High poverty tracts that experienced further economic decline from 1990 to 2010, began the period with the lowest access to services and experienced the smallest increases in access to services. Access was highest and grew the fastest in high poverty tracts that experienced the largest increases in median household income. We theorize that agglomeration benefits and the marketization of welfare may explain the emergence of this spatial mismatch.
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spelling pubmed-89344732022-03-23 Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study Park, Yoosun Quinn, James W. Hurvitz, Philip M. Hirsch, Jana A. Goldsmith, Jeff Neckerman, Kathryn M. Lovasi, Gina S. Rundle, Andrew G. BMC Health Serv Res Research BACKGROUND: To address patient’s unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergence of disparities in spatial access to social services from 1990 to 2014. METHODS: Social service providers in the lower 48 continental U.S. states were identified annually from 1990 to 2014 from the National Establishment Times Series (NETS) database. The addresses of providers were linked in each year to 2010 US Census tract geometries. Time series analyses of annual counts of services per Km(2) were conducted using Generalized Estimating Equations with tracts stratified into tertiles of 1990 population density, quartiles of 1990 poverty rate and quartiles of 1990 to 2010 change in median household income. RESULTS: Throughout the period, social service agencies/Km(2) increased across tracts. For high population density tracts, in the top quartile of 1990 poverty rate, compared to tracts that experienced the steepest declines in median household income from 1990 to 2010, tracts that experienced the largest increases in income had more services (+ 1.53/Km(2), 95% CI 1.23, 1.83) in 1990 and also experienced the steepest increases in services from 1990 to 2010: a 0.09 services/Km(2)/year greater increase (95% CI 0.07, 0.11). Similar results were observed for high poverty tracts in the middle third of population density, but not in tracts in the lowest third of population density, where there were very few providers. CONCLUSION: From 1990 to 2014 a spatial mismatch emerged between the availability of social services and the expected need for social services as the population characteristics of neighborhoods changed. High poverty tracts that experienced further economic decline from 1990 to 2010, began the period with the lowest access to services and experienced the smallest increases in access to services. Access was highest and grew the fastest in high poverty tracts that experienced the largest increases in median household income. We theorize that agglomeration benefits and the marketization of welfare may explain the emergence of this spatial mismatch. BioMed Central 2022-03-19 /pmc/articles/PMC8934473/ /pubmed/35305617 http://dx.doi.org/10.1186/s12913-022-07749-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Park, Yoosun
Quinn, James W.
Hurvitz, Philip M.
Hirsch, Jana A.
Goldsmith, Jeff
Neckerman, Kathryn M.
Lovasi, Gina S.
Rundle, Andrew G.
Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
title Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
title_full Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
title_fullStr Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
title_full_unstemmed Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
title_short Addressing patient’s unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
title_sort addressing patient’s unmet social needs: disparities in access to social services in the united states from 1990 to 2014, a national times series study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934473/
https://www.ncbi.nlm.nih.gov/pubmed/35305617
http://dx.doi.org/10.1186/s12913-022-07749-1
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