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Published, Version of Record (VoR)CC BY V4.0, Open
Journal article
Addressing patient's unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
BMC health services research, v 22(1), pp 367-367
19 Mar 2022
PMID: 35305617
Abstract
To address patient's unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergence of disparities in spatial access to social services from 1990 to 2014.
Social service providers in the lower 48 continental U.S. states were identified annually from 1990 to 2014 from the National Establishment Times Series (NETS) database. The addresses of providers were linked in each year to 2010 US Census tract geometries. Time series analyses of annual counts of services per Km
were conducted using Generalized Estimating Equations with tracts stratified into tertiles of 1990 population density, quartiles of 1990 poverty rate and quartiles of 1990 to 2010 change in median household income.
Throughout the period, social service agencies/Km
increased across tracts. For high population density tracts, in the top quartile of 1990 poverty rate, compared to tracts that experienced the steepest declines in median household income from 1990 to 2010, tracts that experienced the largest increases in income had more services (+ 1.53/Km
, 95% CI 1.23, 1.83) in 1990 and also experienced the steepest increases in services from 1990 to 2010: a 0.09 services/Km
/year greater increase (95% CI 0.07, 0.11). Similar results were observed for high poverty tracts in the middle third of population density, but not in tracts in the lowest third of population density, where there were very few providers.
From 1990 to 2014 a spatial mismatch emerged between the availability of social services and the expected need for social services as the population characteristics of neighborhoods changed. High poverty tracts that experienced further economic decline from 1990 to 2010, began the period with the lowest access to services and experienced the smallest increases in access to services. Access was highest and grew the fastest in high poverty tracts that experienced the largest increases in median household income. We theorize that agglomeration benefits and the marketization of welfare may explain the emergence of this spatial mismatch.
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Details
- Title
- Addressing patient's unmet social needs: disparities in access to social services in the United States from 1990 to 2014, a national times series study
- Creators
- Yoosun Park - University of PennsylvaniaJames W Quinn - Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 west 168th street, room 727, New York, New York, 10032, USA.Philip M Hurvitz - University of WashingtonJana A Hirsch - Drexel UniversityJeff Goldsmith - Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA.Kathryn M Neckerman - Columbia UniversityGina S Lovasi - Drexel UniversityAndrew G Rundle - Columbia University
- Publication Details
- BMC health services research, v 22(1), pp 367-367
- Publisher
- Springer BMC
- Grant note
- 1R01AG049970 / NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Urban Health Collaborative
- Web of Science ID
- WOS:000770763300003
- Scopus ID
- 2-s2.0-85126762866
- Other Identifier
- 991019168805304721
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Health Care Sciences & Services