Social Risk Factors and Their Effect on Health Care Costs in a Midwestern Health Care System

作者：Matthew E. Bernard, Jessica Sosso, Dominika Jegen, Summer V. Allen, Karen M. Fischer, Gerald J. Sobolik, Jadyn R. Dickes, Randy Foss, Julie Maxson, Gregory M. Garrison, Michelle A. Lampman, Tom D. Thacher · 发表于：Journal of Primary Care & Community Health · 年份：2026 · DOI：10.1177/21501319261431146 · 研究领域：Food Security and Health in Diverse Populations、Healthcare Policy and Management、Health disparities and outcomes

Objectives: To assess how social risk factors and socioeconomic status (SES) affect health care costs at a large, integrated health system of 45 clinics in Iowa, Minnesota, and Wisconsin. Methods: We retrospectively reviewed administrative patient cost data from January 1 through December 31, 2022. Social risk factors (lack of financial resources, food insecurity, intimate partner violence, unmet transportation needs, and housing instability) were determined with patient questionnaires. Cost z -scores were compared across all risk-factor quartiles. We used a housing-based measure to objectively determine SES. Results: We analyzed data from 410 624 patients empaneled with 689 family medicine clinicians. Self-reported risk factor data were incomplete for 219 321 patients. Costs were higher for those with higher social risk (mean cost z -score: high risk = 0.38, low risk = 0.11; P < .001). In addition, higher costs were associated with increasing age, greater medical complexity (higher Adjusted Clinical Group scores), White race, and lack of financial resources. Although we observed geographic variations in cost, urban and rural locations did not have significant cost differences. Costs were similar across all quartiles of SES, and the absolute difference in cost z -scores between the highest and lowest SES quartiles was only 0.04. The multivariate analysis, which adjusted for age, medical complexity, race, sex, and objective SES, showed that these specific associations were ...