References
- Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Mackenbach JP, van Lenthe FJ, Mokdad AH, Murray CJL. Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and key drivers. JAMA Intern Med. 2017;177(7):1003–11. doi:https://doi.org/10.1001/jamainternmed.2017.0918.
- Daniel H, Bornstein SS, Kane GC. Addressing social determinants to improve patient care and promote health equity: an American college of physicians position paper. Ann Intern Med. 2018;168(8):577–78. doi:https://doi.org/10.7326/M17-2441.
- Artiga S, Hinton E Beyond health care: the role of social determinants in promoting health and health equity. 2018; https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/view/footnotes/. Accessed April 25, 2020.
- Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. doi:https://doi.org/10.1016/S0140-6736(05)71146-6.
- Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101(8):1456–65. doi:https://doi.org/10.2105/AJPH.2010.300086.
- Kind AJ, Jencks S, Brock J, Yu M, Bartels C, Ehlenbach W, Greenberg C, Smith M. Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study. Ann Intern Med. 2014;161(11):765–74. doi:https://doi.org/10.7326/M13-2946.
- Sills MR, Hall M, Colvin JD, Macy ML, Cutler GJ, Bettenhausen JL, Morse RB, Auger KA, Raphael JL, Gottlieb LM, et al. Association of social determinants with children’s hospitals’ Preventable readmissions performance. JAMA Pediatr. 2016;170(4):350–58. doi:https://doi.org/10.1001/jamapediatrics.2015.4440.
- Prus SG. Comparing social determinants of self-rated health across the United States and Canada. Soc Sci Med. 2011;73(1):50–59. doi:https://doi.org/10.1016/j.socscimed.2011.04.010.
- Nandi A, Glymour MM, Subramanian SV. Association among socioeconomic status, health behaviors, and all-cause mortality in the United States. Epidemiology. 2014;25(2):170–77. doi:https://doi.org/10.1097/EDE.0000000000000038.
- Kroger H, Pakpahan E, Hoffmann R. What causes health inequality? A systematic review on the relative importance of social causation and health selection. Eur J Public Health. 2015;25(6):951–60. doi:https://doi.org/10.1093/eurpub/ckv111.
- Hudon C, Sanche S, Haggerty JL, Wang Y. Personal characteristics and experience of primary care predicting frequent use of emergency department: a prospective cohort study. PLoS One. 2016;11(6):e0157489. doi:https://doi.org/10.1371/journal.pone.0157489.
- McCusker J, Karp I, Cardin S, Durand P, Morin J. Determinants of emergency department visits by older adults: a systematic review. Acad Emerg Med. 2003;10(12):1362–70. doi:https://doi.org/10.1197/S1069-6563(03)00539-6.
- Li G, Grabowski JG, McCarthy ML, Kelen GD. Neighborhood characteristics and emergency department utilization. Acad Emerg Med. 2003;10(8):853–59. doi:https://doi.org/10.1197/aemj.10.8.853.
- Lowe RA, Fu R, Ong ET, McGinnis PB, Fagnan LJ, Vuckovic N, Gallia C. Community characteristics affecting emergency department use by medicaid enrollees. Med Care. 2009;47(1):15–22. doi:https://doi.org/10.1097/MLR.0b013e3181844e1c.
- National Academies of Sciences E, and Medicine. Accounting for social risk factors in medicare payment: identifying social risk factors. Washington DC, USA:National Academies Press;2016.
- Koh HK, Piotrowski JJ, Kumanyika S, Fielding JE. Healthy people: a 2020 vision for the social determinants approach. Health Educ Behav. 2011;38(6):551–57. doi:https://doi.org/10.1177/1090198111428646.
- Joynt Maddox KE, Reidhead M, Hu J, Kind AJH, Zaslavsky AM, Nagasako EM, Nerenz DR. Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program. Health Serv Res. 2019;54(2):327–36. doi:https://doi.org/10.1111/1475-6773.13133.
- Durfey SNM, Kind AJH, Gutman R, Monteiro K, Buckingham WR, DuGoff EH, Trivedi AN. Impact of risk adjustment for socioeconomic status on medicare advantage plan quality rankings. Health Aff (Millwood). 2018;37(7):1065–72. doi:https://doi.org/10.1377/hlthaff.2017.1509.
- Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32(1):381–98. doi:https://doi.org/10.1146/annurev-publhealth-031210-101218.
- Knighton AJ, Stephenson B, Savitz LA. Measuring the effect of social determinants on patient outcomes: a systematic literature review. J Health Care Poor Underserved. 2018;29(1):81–106. doi:https://doi.org/10.1353/hpu.2018.0009.
- Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: the public health disparities geocoding project (US). J Epidemiol Community Health. 2003;57(3):186–99. doi:https://doi.org/10.1136/jech.57.3.186.
- Rubin MS, Colen CG, Link BG. Examination of inequalities in HIV/AIDS mortality in the United States from a fundamental cause perspective. Am J Public Health. 2010;100(6):1053–59. doi:https://doi.org/10.2105/AJPH.2009.170241.
- Wang A, Clouston SA, Rubin MS, Colen CG, Link BG. Fundamental causes of colorectal cancer mortality: the implications of informational diffusion. Milbank Q. 2012;90(3):592–618. doi:https://doi.org/10.1111/j.1468-0009.2012.00675.x.
- Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35:80–94. Spec No. doi:https://doi.org/10.2307/2626958.
- Singh GK. Area deprivation and widening inequalities in US mortality, 1969-1998. Am J Public Health. 2003;93(7):1137–43. doi:https://doi.org/10.2105/AJPH.93.7.1137.
- Carstairs V. Deprivation indices: their interpretation and use in relation to health. J Epidemiol Community Health. 1995 Suppl 2(Suppl 2);49(Suppl 2):S3–8. doi:https://doi.org/10.1136/jech.49.Suppl_2.S3.
- Messer LC, Laraia BA, Kaufman JS, Eyster J, Holzman C, Culhane J, Elo I, Burke JG, O’Campo P. The development of a standardized neighborhood deprivation index. J Urban Health. 2006;83(6):1041–62. doi:https://doi.org/10.1007/s11524-006-9094-x.
- US Census. 2000 Summary file 1 technical documentation: appendix A. 2000.
- US Census. 2010 Summary file 2 technical documentation: appendix A. 2010.
- American community survey 1-year estimates. In: Bureau USC, ed2011 to 2017.
- Food access research atlas. In: Economic Research Service USDoA. editor.
- The center for the evaluative clinical sciences. The dartmouth atlas of health care. In: School DM. ed1996
- Office of Policy Development and Research. HUD USPS zip code crosswalk files. In: Research, ed. Development. 2019. https://www.huduser.gov/portal/datasets/usps_crosswalk.html. Accessed April 25, 2020.
- Zip code crosswalks. In: Project DA.editor. Lebanon:NH2019
- Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334. doi:https://doi.org/10.1007/BF02310555.
- Geocorr. 2014. Geographic correspondence engine. In: Center MCD.editor. University of Missouri;2016.
- Kendall MG. A NEW MEASURE OF RANK CORRELATION. Biometrika. 1938;30(1–2):81–93. doi:https://doi.org/10.1093/biomet/30.1-2.81.
- O’Neill M. Census zip code tabulation areas.In: California:2010. Development COoSHPa. ed2010
- TIGERweb Nation-Based Data Files. In: Census U, ed2019.
- ArcGIS desktop: release 10 [computer program]. Redlands (CA): ESRI; 2011.
- Hou F, Myles J. Neighbourhood inequality, neighbourhood affluence and population health. Soc Sci Med. 2005;60(7):1557–69. doi:https://doi.org/10.1016/j.socscimed.2004.08.033.
- Livingston S In Depth: payers can’t control costs without social determinants of health model. In: Modern Healthcare; 2018.
- Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet. 2008;372(9650):1661–69. doi:https://doi.org/10.1016/S0140-6736(08)61690-6.
- Nobel L, Jesdale WM, Tjia J, Waring ME, Parish DC, Ash AS, Kiefe CI, Allison JJ. Neighborhood socioeconomic status predicts health after hospitalization for acute coronary syndromes: findings from TRACE-CORE (transitions, risks, and actions in coronary events—center for outcomes research and education. Med Care. 2017;55(12):1008–16. doi:https://doi.org/10.1097/MLR.0000000000000819.
- Bhavsar NA, Gao A, Phelan M, Pagidipati NJ, Goldstein BA. Value of Neighborhood socioeconomic status in predicting risk of outcomes in studies that use electronic health record data. JAMA Network Open. 2018;1(5):e182716–e182716. doi:https://doi.org/10.1001/jamanetworkopen.2018.2716.
- Pantell MS, Prather AA, Downing JM, Gordon NP, Adler NE. Association of social and behavioral risk factors with earlier onset of adult hypertension and diabetes. JAMA Network Open. 2019;2(5):e193933–e193933. doi:https://doi.org/10.1001/jamanetworkopen.2019.3933.
- Woolf SH, Braveman P. Where health disparities begin: the role of social and economic determinants—and why current policies may make matters worse. Health Aff (Millwood). 2011;30(10):1852–59. doi:https://doi.org/10.1377/hlthaff.2011.0685.
- Roberts ET, Zaslavsky AM, Barnett ML, Landon BE, Ding L, McWilliams JM. Assessment of the effect of adjustment for patient characteristics on hospital readmission rates: implications for pay for performance. JAMA Intern Med. 2018;178(11):1498–507. doi:https://doi.org/10.1001/jamainternmed.2018.4481.
- Nguyen CA, Gilstrap LG, Chernew ME, McWilliams JM, Landon BE, Landrum MB. Social risk adjustment of quality measures for diabetes and cardiovascular disease in a commercially insured US population. JAMA Network Open. 2019;2(3):e190838–e190838. doi:https://doi.org/10.1001/jamanetworkopen.2019.0838.
- Hatef E, Searle KM, Predmore Z, Lasser EC, Kharrazi H, Nelson K, Sylling P, Curtis I, Fihn SD, Weiner JP, et al. The impact of social determinants of health on hospitalization in the veterans health administration. Am J Prev Med. 2019;56(6):811–18. doi:https://doi.org/10.1016/j.amepre.2018.12.012.
- Bernheim SM, Parzynski CS, Horwitz L, Lin Z, Araas MJ, Ross JS, Drye EE, Suter LG, Normand SLT, Krumholz HM, et al. Accounting for patients’ socioeconomic status does not change hospital readmission rates. Health Aff (Millwood). 2016;35(8):1461–70. doi:https://doi.org/10.1377/hlthaff.2015.0394.
- Adler NE, Glymour MM, Fielding J. Addressing social determinants of health and health inequalities. JAMA. 2016;316(16):1641–42. doi:https://doi.org/10.1001/jama.2016.14058.
- Chin MH. Creating the business case for achieving health equity. J Gen Intern Med. 2016;31(7):792–96. doi:https://doi.org/10.1007/s11606-016-3604-7.
- Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64(4):284. doi:https://doi.org/10.1136/jech.2008.082743.
- Kasthurirathne SN, Vest JR, Menachemi N, Halverson PK, Grannis SJ. Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services. J Am Med Inform Assoc. 2017;25(1):47–53. doi:https://doi.org/10.1093/jamia/ocx130.