The relationship between social determinants of health and functional capacity in adult primary care patients with multiple chronic conditions

Abstract

Purpose: Social determinants of health (SDoH) including insecure access to food, housing, and financial resources are critical threats to overall health. We sought to examine this relationship among adult primary care patients with multiple chronic conditions. Methods: We obtained cross-sectional data on 2763 adults with chronic medical and behavioral conditions or greater than 2 chronic medical conditions from a survey of participants in Integrating Behavioral Health and Primary Care, a multicenter randomized trial. Results: The prevalence of 1 or more insecurities was reported in 29% of participants, including food (13%), housing (3%), or financial (25%). Functional capacity ranged from 2.74 to 9.89 metabolic equivalents (METs) (median, 6.05). The distribution of functional capacity was significantly lower for those with any 1 or more SDoH than for those without. Each insecurity independently affected the functional capacity in multivariable analysis. Conclusions: Among primary care patients with chronic conditions, SDoH are associated with poorer functional capacity, independent of other social and demographic factors. Primary care offers a promising, if underused, opportunity to intervene in SDoH. There is a need for future studies to explore the role of screening and intervention by primary care providers to mitigate or prevent SDoH. (J Am Board Fam Med 2021;34:688–697.)