Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4096 — Mapping the Evidence: Social Determinants of Veteran Health

Lead/Presenter: Wei Duan-Porter, COIN - Minneapolis
All Authors: Duan-Porter W (Minneapolis VA) Martinson BC (Minneapolis VA) Greer NL (Minneapolis VA) Gnan KE (Minneapolis VA) MacDonald R (Minneapolis VA) McKenzie LG (Minneapolis VA) Rosebush CE (Minneapolis VA) Taylor BC (Minneapolis VA) Falde SD (University of Minnesota, Twin Cities) Wilt TJ (Minneapolis VA)

Objectives:
Understanding how social determinants impact Veteran health is critical for improving care quality and addressing disparities in health outcomes. At the request of VHA Population Health Services and Office of Rural Health, the Minneapolis VA Evidence-based Synthesis Program sought to: 1) describe published evidence for differences in social determinants of health between Veterans and non-Veterans, and 2) examine how such social determinants may contribute to differences in health outcomes, health services utilization, and health-related behaviors between these groups.

Methods:
We developed a conceptual framework to align with the key questions and focus the scope of our evidence map. We searched PubMed, Sociological Abstracts, PsycINFO, and CINAHL for English-language articles addressing social determinants of health (e.g., education, employment, income, social support and rurality) for Veterans and non-Veterans. We used descriptive statistics to summarize key characteristics of included studies, such as study design, participant numbers, social determinants examined, and main outcomes. We prioritized studies on key social determinants and outcomes to identify a subset of included studies for more detailed data abstraction and analysis (ongoing).

Results:
We screened 7244 unique citations, 453 studies underwent full-text review, and approximately 33% of these were eligible. Nearly all studies used cross-sectional surveys ( > 80%) and few were longitudinal cohorts. Nearly 70% of eligible studies addressed education, with income, employment, and marital status being the next most frequently included social determinants (43-50% of eligible studies). Fewer eligible studies examined rurality (18%), social support (11%), or history of trauma (10%). Studies infrequently evaluated the role of social determinants in health outcomes (30%), health services utilization (20%), or health related behaviors (10%).

Implications:
Most studies utilized cross-sectional designs, and more studies addressed traditional socio-economic status indicators, such as education and income, while few addressed social support or history of trauma.

Impacts:
This evidence map will help VHA develop policy and guide operations planning for health care services that may be influenced by certain social determinants contributing to poorer health and greater care needs, especially among medically complex Veterans. Future studies should use longitudinal data over a sufficient time period, employ multivariate adjustment, and assess mediation/moderation as appropriate.