Assessing Area-Level Deprivation as a Proxy for Individual-Level Social Risks

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Equity

Background:

• Healthcare organizations explore social deprivation indices as proxies for individual social needs due to cost concerns.
• The effectiveness of using area-level social risks instead of individual-level assessments is not well understood across diverse populations.

Purpose of the Study:

• To evaluate the accuracy of area-level social risk measures (Social Deprivation Index, Area Deprivation Index, Neighborhood Stress Score) in identifying individual-level social risks.
• To compare the performance of different area-level indices against individual social risks and combinations.

Main Methods:

• Analysis of a national sample of Medicare Advantage members (N=77,503).
• Comparison of the highest quartile of three area-level social risk measures against six individual-level social risks and three risk combinations.
• Calculation of agreement, sensitivity, specificity, positive predictive values, and negative predictive values.

Main Results:

• Agreement between area-level and individual-level social risks ranged from 53% to 77%.
• Sensitivity never exceeded 42%, while specificity ranged from 62% to 87%.
• Positive predictive values varied from 8% to 70%, and negative predictive values ranged from 48% to 93%.

Conclusions:

• Area-level deprivation indices demonstrate inconsistency as indicators of individual social risks.
• Findings support the implementation of individual-level social needs screening programs in healthcare.
• Direct screening is crucial for accurately identifying and addressing patient social needs.