Financial, Housing, Food Insecurity Raises Risk of Hospital, ED Visits

Exposure to social risk factors, such as food instability, housing insecurity, and financial stress, among others, could contribute to upticks in health care resource utilization, suggested a new study published today in JAMA Network Open.1 Although these findings warrant further investigation, insured adults who encountered these health-related risks exhibited higher rates of hospitalizations and emergency department (ED) visits.

Social determinants of health influence health outcomes like ED visits. | image credit: Viktor Birkus - stock.adobe.com

Financial, housing, and food instability are the 3 most prevalent social risk factors affecting people in the US. As the present authors point out, these factors are often interrelated and compound one another. Literature on these subjects over the years has suggested a link between health care resource utilization, adverse health outcomes, and exposure to social risks2-4; however, this research has had its limitations. These previous studies had narrower focuses on single risk factors, failed to analyze their relationship with one another and their potential to change over time, and were methodically weak (single-site evaluations, cross-sectional designs, etc).1

“Adults experiencing social risk may delay care for emerging health issues resulting in increased severity of health conditions and subsequently greater risk of ED utilization and hospitalization,” the authors wrote. To investigate this relationship further and combat previous limitations, they analyzed data on a larger scale by evaluating a more geographically diverse and integrated health care delivery system.

Data were gathered from adult patients who are insured through Kaiser Permanente (KP), which spans 8 regions throughout the US. KP National Social Needs Survey (NSNS) data and electronic health records were also leveraged. The first phase of the survey was administered between January and September 2020, with a second being administered between June 2022 and February 2023.

The final analytic cohort included 9785 adults. Respondents were a mean 48.4 years old, just over 54% were female (95% CI, 52.3%-55.9%), 43.5% were White (95% CI, 41.2%-44.7%), 27.1% were Hispanic (95% CI, 25.5%-28.8%), 14.6% were Asian (95% CI, 13.3%-16.0%), and 8.1% were Black (95% CI, 7.3%-9.1%).

Nearly 14% (95% CI, 12.7%-15.2%) of respondents self-reported their health as fair to poor. In the initial survey, over 50% registered positive for 1 or more social risk factors, with over 40% reporting financial stress, 30% food insecurity, and more than 16% unstable housing. They were more like to report at least 1 social risk factor if they were younger (aged 18-34; 34.1% vs 22.3%), Hispanic (34.8% vs 19.4%), had less education (achieved General Educational Development accreditation or graduated high school; 28.6% vs 15%), have never been married (25.3% vs 15.1%), and self-reported poorer health (19.3% vs 8.5%) compared with individuals who had not reported any social risk.

After completing the initial survey, the first ED visit (25.4%) or hospitalization (10.3%) occurred after a median of 3.48 years. Those exposed to social risks experienced ED visits at rates of 115 visits (95% CI, 104.3-126.8) per 1000 person-years compared with 86.9 visits (95% CI, 78.6-96.1) for those without exposure. Individuals who had risk exposure also had higher rates of hospitalization compared with those without exposure (40.6 vs 33.8 per 1000 person-years).

Their analysis yielded conflicting results. Although their findings demonstrate increased incidences in ED visits or hospitalization following social risk exposure, hospitalization rates were not significantly associated with social risk.

“While varied, our findings add to the evidence suggesting that social risk is common, even among an insured population cared for in an integrated health care delivery system,” the authors stated.

As they concluded, they pointed to the fact that 15.6% of those who completed both surveys exhibited changes in financial, stable housing, or food security status, “suggesting that social risk is not fixed and may evolve with some individuals moving in and out of risk.” This variability demonstrates the need for more dedicated research efforts in this area to better elucidate the influence and relationship between social risk and health care resource utilization, they added.

References

1. Clennin M, Shootman M, Tucher EL, et al. Social risk and acute health care utilization among insured adults. JAMA Netw Open. 2025;5;8(4):e254253. doi:10.1001/jamanetworkopen.2025.4253

2. Malecha PW, Williams JH, Kunzler NM, Goldfrank LR, Alter HJ, Doran KM. Material needs of emergency department patients: a systematic review. Acad Emerg Med. 2018;25(3):330-359. doi:10.1111/acem.13370

3. Yan AF, Chen Z, Wang Y, et al. Effectiveness of social needs screening and interventions in clinical settings on utilization, cost, and clinical outcomes: a systematic review. Health Equity. 2022;6(1):454-475. doi:10.1089/heq. 2022.0010

4. Ardekani A, Fereidooni R, Heydari ST, Ghahramani S, Shahabi S, Bagheri Lankarani K. The association of patient-reported social determinants of health and hospitalization rate: a scoping review. Health Sci Rep. 2023;6 (2):e1124. doi:10.1002/hsr2.1124