Associations Between Social Risk Factors and Acute-Care Use Among Patients With Rheumatic Conditions

Patients with social risk factors are more likely to have poorer health outcomes. We examined associations between social risk factors and acute-care use (emergency department [ED] visits and hospitalizations) among patients with rheumatic conditions.

We identified patients with International Classification of Diseases, Tenth Revision, codes for rheumatic conditions on at least two encounters receiving rheumatology care at a multihospital system who completed social risk factor screening. We used negative binomial models, adjusted for sociodemographics and comorbidities, to estimate incidence rates and incidence rate ratios (IRRs) for ED visits and hospitalizations, as well as preventable ED visits, by social risk factor presence.

Among 9,590 patients, 1,614 (17%) reported at least one social risk factor. Adjusted models revealed higher rates of ED visits (IRR 1.74, 95% confidence interval [CI] 1.53-1.98) and hospitalizations (IRR 1.96, 95% CI 1.60-2.43) among patients with versus without social risk factors. Food insecurity, housing insecurity, transportation challenges, difficulties with medication costs, utility bill needs, education needs, and caregiving needs were each individually associated with higher rates of ED visits and hospitalizations. Unemployment was associated with higher rates of ED visits only; digital access needs were associated with higher rates of hospitalizations only. We found no association between the presence versus absence of social risk factors and rates of preventable ED visits.

Among patients with rheumatic conditions, social risk factor presence was associated with higher rates of acute-care use but not with preventable ED visits. Further studies are needed to determine whether addressing social risk factors can alter care use patterns.