The Impact of Social Determinants of Health on Hospitalization in the Veterans Health Administration

Am J Prev Med. 2019 Jun;56(6):811-818. doi: 10.1016/j.amepre.2018.12.012. Epub 2019 Apr 17.


Introduction: This study aims to assess the effect of individual and geographic-level social determinants of health on risk of hospitalization in the Veterans Health Administration primary care clinics known as the Patient Aligned Care Team.

Methods: For a population of Veterans enrolled in the primary care clinics, the study team extracted patient-level characteristics and healthcare utilization records from 2015 Veterans Health Administration electronic health record data. They also collected census data on social determinants of health factors for all U.S. census tracts. They used generalized estimating equation modeling and a spatial-based GIS analysis to assess the role of key social determinants of health on hospitalization. Data analysis was completed in 2018.

Results: A total of 6.63% of the Veterans Health Administration population was hospitalized during 2015. Most of the hospitalized patients were male (93.40%) and white (68.80%); the mean age was 64.5 years. In the generalized estimating equation model, white Veterans had a 15% decreased odds of hospitalization compared with non-white Veterans. After controlling for patient-level characteristics, Veterans residing in census tracts with the higher neighborhood SES index experienced decreased odds of hospitalization. A spatial-based analysis presented variations in the hospitalization rate across the Veterans Health Administration primary care clinics and identified the clinic sites with an elevated risk of hospitalization (hotspots) compared with other clinics across the country.

Conclusions: By linking patient and population-level data at a geographic level, social determinants of health assessments can help with designing population health interventions and identifying features leading to potentially unnecessary hospitalization in selected geographic areas that appear to be outliers.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Ambulatory Care Facilities / statistics & numerical data
  • Comorbidity
  • Female
  • Geographic Information Systems
  • Hospitalization / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Racial Groups / statistics & numerical data
  • Sex Factors
  • Social Determinants of Health / statistics & numerical data*
  • Socioeconomic Factors
  • United States
  • United States Department of Veterans Affairs / statistics & numerical data*