Racial and Ethnic Differences in Social Determinants of Health and Health-Related Social Needs Among Adults — Behavioral Risk Factor Surveillance System, United States, 2022

Methods

Data Source

BRFSS is a state-based landline and cellular telephone survey of noninstitutionalized U.S. civilian residents aged ≥18 years.^† BRFSS collects data on health-related risk behaviors, chronic diseases and conditions, health care access, and use of preventive services in all 50 states, the District of Columbia, and participating U.S. territories. The optional SD/HE module was introduced in 2022. Details of the 2022 BRFSS survey and SD/HE module are described elsewhere (5); data were collected by 39 states, District of Columbia, Puerto Rico, and U.S. Virgin Islands.^§ SD/HE module questions were developed based on the Center for Medicare & Medicaid Services’ Accountable Health Communities Health-Related Social Needs Screening Tool^¶ and from a previous BRFSS SDOH optional module administered in 2017.** SDOH measures include employment instability, food insecurity, housing insecurity, utility insecurity, and lack of reliable transportation. HRSN measures included life dissatisfaction, lack of social and emotional support, social isolation or loneliness, receiving food stamps or Supplemental Nutrition Assistance Program (SNAP), and mental stress. Two additional adverse SDOH measures, lack of health insurance and cost barrier for needed medical care, were from the BRFSS core section (Box).

Prevalence of adverse SDOH and HRSN were examined by race and ethnicity, which were categorized as non-Hispanic (NH) American Indian or Alaska Native (AI/AN), NH Asian (Asian), NH Black or African American (Black), NH Native Hawaiian or other Pacific Islander (NH/OPI), NH White (White), NH multiracial (multiracial), or Hispanic or Latino (Hispanic) based on self-identified race and ethnicity information. The analysis included 323,877 participants (among 338,778 survey respondents) with complete demographic and general health status information.

Data Analysis

Those who responded “don’t know/not sure,” refused to answer, or had missing responses for demographic variables (except for those with unknown income) were excluded. Participants with missing information for a specific SDOH or HRSN were excluded from the respective analyses.

Weighted^†† prevalence estimates were calculated overall and by racial and ethnic group, U.S. Census Bureau regions, and covariates (age, sex, education, marital status, income, and self-rated health). Statistical significance was determined based on whether there was an overlap between 95% CIs for any two estimates. Adjusted prevalence estimates were obtained by conducting log-linear regression analyses with a robust variance estimator, which adjusted for covariates. Analyses were conducted using SAS-callable SUDAAN (version 11.0.3; RTI International) to account for the complex survey design. This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.^§§