Effect of Unmet Social Health Needs on Patients’ Physical, Mental, and Financial Health after Traumatic Injury

INTRODUCTION: Traumatic injuries are a major health problem among older adults who are vulnerable to poor outcomes across a variety of health domains. Social determinants of health are known to be associated with well-being; however, the association between unmet social health needs and long-term outcomes after major injury remains poorly understood. METHODS: We used inpatient Medicare claims linked to the biannual Health and Retirement Study to identify individuals older than 65 years admitted for a traumatic injury in 1998 to 2016 with an injury severity score greater than 4. Preinjury Health and Retirement Study survey questions identified patients with any of the following 3 unmet social health needs: food insecurity, unsafe housing, or inadequate transportation. We then evaluated physical, mental, and financial health outcomes during the first postinjury interview including self-reported health, depression, functional status, out-of-pocket medical spending, and total household assets. All outcomes were evaluated with generalized linear mixed models accounting for complex survey design. RESULTS: Our weighted sample consisted of 6,730,414 patients during the 18-year study period, and 44.9% of patients had at least 1 unmet social health need (5.9% food insecurity, 9.1% unsafe housing, 39.0% inadequate transportation). Compared with patients with no unmet social health needs, those with 2 or more unmet social health needs had worse long-term outcomes across all domains of health (Table).CONCLUSION: Two of every five older trauma survivors have unmet social health needs, which are associated with worse postinjury outcomes across all domains of health. Programs that address unmet social health needs are needed to optimize recovery after major injury.