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Racial, Ethnic, and Sex Differences in Social Risks and Social Needs Concordance Among Veterans.
Lauren E Russell1, David A Frank2, Soumik Purkayastha2,3
1Office of Health Equity, Veterans Health Administration, Washington, DC.
JAMA Network Open
|February 17, 2026
Summary
Social risk screening accurately identifies those without needs but underdetects needs in Black male veterans. Improved survey methods are crucial for equitable detection of social support needs across diverse veteran populations.
Area of Science:
- Health Services Research
- Social Determinants of Health
- Health Equity
Background:
- Social screening initiatives aim to identify social risks to offer support.
- The effectiveness of social risk screening in accurately detecting needs, especially across demographic subgroups, requires further investigation.
- Potential for overscreening or underdetection of needs exists within current social risk assessment frameworks.
Purpose of the Study:
- To evaluate the concordance between self-reported social risks and needs for support.
- To analyze how risk-need concordance varies across racial, ethnic, and sex subgroups.
- To identify potential disparities in social needs detection within the Veterans Health Administration (VA) patient population.
Main Methods:
- Cross-sectional study utilizing survey data from VA patients who visited primary care.
- Online or mailed surveys collected data on social risks and needs across 12 domains.
- Analysis involved calculating risk-need sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and concordance, with adjustments for age and potential biases using survey weights.
Main Results:
- Social risk screening demonstrated high sensitivity for loneliness (99%) and high specificity for childcare needs (98%).
- Positive predictive values varied significantly, with housing needs showing a low PPV (27%).
- Black male veterans showed a higher likelihood of need-without-risk discordance for basic needs and housing compared to White male veterans. Significant discordance for loneliness was also observed in White female, Hispanic female, and Hispanic male veterans.
Conclusions:
- Current social risk screening effectively identifies veterans without needs but underdetects needs among specific subgroups, notably Black male veterans.
- Disparities in the detection of social needs exist, highlighting the need for culturally sensitive and accurate assessment tools.
- Enhanced survey methodologies are essential to ensure equitable identification and support for diverse veteran populations.
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