Association of home based primary care enrollment with social determinants of health for older veterans

BACKGROUND:Home-based Primary Care (HBPC) provides comprehensive primary care to Veterans who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran's social needs. OBJECTIVE:To estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of Veterans. METHODS:We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. RESULTS:In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. CONCLUSIONS:More research is needed to determine the relationship between Veterans' social needs and HBPC enrollment.