Social Risk Domains and Emergency Room Visits among Adults with Diabetes and Low Income

Background: In the U.S., more than 34 million adults ≥18 years of age are estimated to have diabetes. Adults with low-income levels are disproportionately impacted. Adverse social conditions associated with poor health, or social risk factors, contribute to poorer access to care, lower quality of care, and worsened clinical outcomes among these adults. The objective of this study was to assess the relationship between social risk domains and hospital utilization among adults with diabetes and low income. Methods: Data of 5,077 adults with diabetes and income <$50,000 or receiving income or assistance from welfare programs or disability insurance (weighted sample = 41,735,609) from the National Health Interview Survey (NHIS) were analyzed. The outcomes were “Have visited the Emergency Room (ER) about own health in past 12 months (yes/no)”, and “Number of times visited ER in past 12 months”. The independent variables were five social risk domains (economic instability, neighborhood and built environment, education access, food insecurity, social and community context). Covariates included age, sex, race/ethnicity, insurance, marital status, employment, comorbidity, region. Logistic regression models were used to assess the independent association between each outcome and each social risk domain. Results: In the fully adjusted model, adults with social and community context risks had a 76% higher risk of visiting the emergency room for their own health in the past 12 months. Also, for each unit increase in the number of times an adult visited the emergency room, there was a significant association with economic instability (βeta (β) coefficient=0.39, (95% CI 0.14, 0.64)), food insecurity (β=0.31, (95% CI 0.13, 0.50)), and social/community risk (β=0.54, (95% CI 0.38, 0.70)). Conclusions: These findings suggest the need for mitigating the influence of social and community factors, economic instability, and food insecurity among adults with diabetes and low income to reduce ER visits. Disclosure J.S.Williams: None. Y.Xu: None. S.Bhandari: None. M.N.Ozieh: None. O.J.Akinboboye: None. L.E.Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861, R21DK123720)