Routinely asking patients about income in primary care: a mixed-methods study

Area of Science:

• Public Health
• Health Services Research
• Sociology

Background:

• Income is a critical social determinant of health.
• Routinely collecting income data and integrating it with electronic health records (EHRs) is uncommon.
• Addressing income-related health disparities requires accessible patient data.

Purpose of the Study:

• To investigate response bias in patient income reporting within primary care.
• To evaluate patient perceptions and comfort levels when asked about income.
• To assess the feasibility of integrating income data into EHRs for health equity research.

Main Methods:

• A mixed-methods study was conducted in a large, multi-site primary care organization in Toronto, Canada.
• Data from 14,247 patients' EHRs were analyzed, comparing income survey responders and non-responders.
• Semi-structured interviews were conducted with 27 patients to explore their perspectives on income-related questions.

Main Results:

• 73% of patients (10,441) responded to both income questions regarding total family income and household size.
• Lower response rates were observed among female patients, ethnic minorities, caregivers of young children, and older adults.
• Patient comfort increased when the connection between income and health was clear and data use for care improvement was communicated; however, some found income estimation difficult or options inadequate for fluctuating incomes.

Conclusions:

• A significant portion of patients are willing to provide income data in primary care settings.
• Challenges in accurately estimating income and reflecting financial variability persist.
• Linking self-reported income data to EHRs can be instrumental in identifying health inequities and informing anti-poverty interventions.