Low-Income Zip Codes Tied to Lack of Access to Care, SDOH

According to an athenahealth study, data demonstrated that patients in low-income zip codes were less likely than patients in high-income zip codes to schedule an annual wellness visit indicating that social determinates of health impact patient access to care.

The research was based on an estimated 7 million patients, including 4.6 million high-risk patients with two or more chronic conditions.

The data concluded that 39 percent of patients in high-income zip codes with a median income scheduled a wellness exam within 90 days of their eligibility. Meanwhile, 37 percent of high-risk patients in medium-income zip codes designed their wellness visit within 90 days of their eligibility.

Finally, only 33 percent of high-risk patients in low-income zip codes scheduled a wellness visit within 90 days of their eligibility.

Patients with the highest risk are more likely to be 60 years old. The study stated that after adjusting for age, high-risk patients are disproportionately likely to live in low-income zip codes and identify as Black or African American.

“The problem that our health system faces today is that the sickest patients who most need continuous, consistent, preventive care often face not only challenges related to their illness, but systemic barriers to accessing care. Thus, the social determinants of health are also the social determinants of access,” Jessica Sweeney-Platt, president of research and editorial strategy at athenahealth, said in a statement.

Researchers highlighted that individuals in low-income zip codes struggle with other obstacles to care, including lack of insurance or inability to receive time off work for doctor’s appointments.

The data shows an inconsistency between care gap closure at federally qualified health centers (FQHCs) in comparison to non-FQHCS that may not have access to a clinic. For example, FQHCs close care gaps about 37 percent of the time, while non-FQHCs close care gaps 27 percent of the time.

“What we see is that for those patients that do identify any social determinant of health, it’s not just one factor,” said the director of quality at True Health, Nurez Madhany. “It’s all of the factors, or at least the majority of the factors. And almost all of those patients are, by default, lower socioeconomic status.”

Researchers did notice a variation in organizations that embedded social programs that address patients’ needs, such as substance abuse counseling, diabetes education programs, and tai chi classes, to name just a few.