Using a Social Determinants of Health Summary Measure to Predict General Health Status in the BRFSS

This study aims to assess the relationship between social determinants of health (SDoH) burden and overall health.

Three years of Behavioral Risk Factor Surveillance System (BRFSS) data (2017-2019) were combined for this cross-sectional study.

Massachusetts.

Out of a possible 21,312 respondents, 16,929 (79%) were eligible for inclusion.

To create the SDoH summary measure, items assessing social risk experiences including financial instability (1 item), housing instability (2 items), perceptions of neighborhood crime (1 item), and food insecurity (2 items) were summed to create a count of risk experiences. Outcome measures included self-rated general health, days of poor physical health, and days of poor mental health.

Multivariable logistic regression was used to evaluate the association between each outcome and the SDoH summary measure, adjusting for demographic confounders.

In adjusted analyses, respondents who reported experiencing 1, 2, 3, or 4+ SDoH had a 1.6 (95% CI: 1.3-2.0), 2.9 (95% CI: 2.3-3.7), 3.2 (95% CI: 2.4-4.3), or 5.3 (95% CI: 4.0-7.0) increased odds (respectively) of self-rated fair/poor health, compared to those who reported zero SDoH. The adjusted relationship between the SDoH summary measure and physical health and mental health was similar in magnitude and statistically significant.

These results demonstrate that the overall burden of risk due to SDoH is an important predictor of health.