Association of the Social Determinants of Health With Quality of Primary Care

Ann Fam Med. 2018 May;16(3):217-224. doi: 10.1370/afm.2236.


Purpose: In primary care, there is increasing recognition of the difficulty of treating patients' immediate health concerns when their overall well-being is shaped by underlying social determinants of health. We assessed the association of social complexity factors with the quality of care patients received in primary care settings.

Methods: Eleven social complexity factors were defined using administrative data on poverty, mental health, newcomer status, and justice system involvement from the Manitoba Population Research Data Repository. We measured the distribution of these factors among primary care patients who made at least 3 visits during 2010-2013 to clinicians in Manitoba, Canada. Using generalized linear mixed modeling, we measured 26 primary care indicators to compare the quality of care received by patients with 0 to 5 or more social complexity factors.

Results: Among 626,264 primary care patients, 54% were living with at least 1 social complexity factor, and 4% were living with 5 or more. Social complexity factors were strongly associated with poorer outcomes with respect to primary care indicators for prevention (eg, breast cancer screening; odds ratio [OR] = 0.77; 99% CI, 0.73-0.81), chronic disease management (eg, diabetes management; OR = 0.86; 99% CI, 0.79-0.92), geriatric care (eg, benzodiazepine prescriptions; OR = 1.63; 99% CI, 1.48-1.80), and use of health services (eg, ambulatory visits; OR = 1.09; 99% CI, 1.08-1.09).

Conclusions: Linking health and social data demonstrates how social determinants are associated with primary care service provision. Our findings provide insight into the social needs of primary care populations, and may support the development of focused interventions to address social complexity in primary care.

Keywords: administrative data; health care disparities; personalized medicine; practice-based research; primary care; quality of care; social determinants of health; social medicine; vulnerable populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Chronic Disease / epidemiology*
  • Chronic Disease / therapy
  • Female
  • Humans
  • Income*
  • Infant
  • Infant, Newborn
  • Linear Models
  • Male
  • Manitoba / epidemiology
  • Middle Aged
  • Primary Health Care / standards*
  • Quality Indicators, Health Care*
  • Social Determinants of Health*
  • Young Adult