Social determinants of health and high-cost utilization among commercially insured population

To assess the impact of adding neighborhood social determinants of health (SDOH) data to demographic and clinical characteristics for predicting high-cost utilizers and to examine variations across age groups.

Using US Census data and 2017-2018 commercial claims from a large national insurer, we estimated association between neighborhood-level SDOH and the probability of being a high-cost utilizer.

Observational study using administrative claims from a national insurer and US Census data. Data included a 50% random sample of commercially insured individuals who were younger than 89 years and had 1 year of continuous eligibility in 2017 and at least 30 days in 2018. Probit models assessed impact of SDOH and neighborhood conditions on predicting cost status.

SDOH did not improve predictive power of evaluated models. However, disadvantaged neighborhood residence was still associated with being a high-cost utilizer. Adults 65 years and older in disadvantaged neighborhoods had increased likelihood of high-cost utilization. Children and younger adults in disadvantaged neighborhoods had lower risk of becoming high-cost utilizers.

Policy makers and industry stakeholders should be aware of the mechanisms behind the relationship between neighborhood social conditions and health outcomes and how the relationship differs across age groups.