RISE looks at recent headlines concerning social determinants of health (SDoH).

The most common reason patients turned to telehealth amid COVID-19

Mental health was the leading treatment in telehealth since the onset of the COVID-19 pandemic, according to a new study published by RAND Corp.

There has been a dramatic shift to telehealth amid the COVID-19 pandemic, and researchers have found that the services have been used for a behavioral health condition by more than 50 percent of 2,052 patients, with 30 percent of those patients using video services.

Other key findings:

  • When the pandemic began, more than 39 percent of patients were being treated for a chronic physical health condition and 15 percent for a behavioral health condition
  • Since the pandemic started, 16 percent of patients have considered seeking care for a new or recurrent condition
  • Use of telehealth for behavioral health conditions was lower among females than males, those age 60 and older than younger ages, non-Hispanic Whites than non-Hispanic Blacks, and those with less than a high school education than those with a college degree
  • A lack of insurance coverage was associated with lower telehealth use for new health conditions
  • Use of telehealth was more common in the Northeast than any other regions

“If telehealth use is going to remain high, we need to ensure equity of access, particularly for behavioral health care where education, age, and gender were all associated with levels of use,” said Dr. Shira Fischer, the study’s lead author and a physician researcher at RAND, in a statement.

Pharmacy access linked to health disparities

A University of California, Irvine (UCI) study has provided the first record of “pharmacy deserts” in the state of California in relation to SDoH. The findings indicate how SDoH, such as transportation, crime rates, and poverty, influence pharmacy access and health disparities.

“My goal is to bring these concepts together at the intersection of pharmacy practice, public health and social justice to reduce health disparities,” said Cheryl Wisseh, a health sciences assistant clinical professor of clinical pharmacy practice at UCI and the study’s first author.

The study, published in the Journal of Racial and Ethnic Health Disparities, analyzed pharmacy deserts, which researchers defined as communities with the nearest pharmacy more than one mile away, throughout Los Angeles county and their SDoH compositional elements.

Key findings include:

  • Twenty-five percent of Los Angeles counties were identified as pharmacy deserts
  • Twenty-four percent of Los Angeles residents live in a pharmacy desert
  • Pharmacy deserts were found to have less non-Hispanic white and non-Hispanic Asian residents
  • Many of the deserts had a higher population of residents who identified as Hispanic, spoke English as a second language, and did not have a high school diploma
  • More pharmacy desert residents were under 18 years of age when compared to residents age 65 or older
  • Residents who lived in pharmacy deserts tended to not own their own vehicle or home and lived below the federal poverty line
  • Pharmacy desert residents likely lacked health insurance

Study underscores link between SDoH and COVID-19 racial disparities

A recent study from Rutgers New Jersey Medical School found SDoH to contribute to the disproportionate impact of COVID-19 on Black Americans. Using data from publicly available databases on COVID-19 death rates through October 2020, researchers found counties with higher death rates had a higher proportion of Black residents and greater levels of SDoH. In fact, a one percent increase in the percent of Black residents within a county was associated with a .9 percent increase in COVID-19 death. Researchers also found a one percent increase in certain key SDoH, including the number of uninsured adults, rate of low birthweight, number of adults without a high school diploma, incarceration rate, and number of households without internet access, linked to an increase in COVID-19 death at the county level.

“Consistent with recent reports, our epidemiologic assessment at the county level indicates that the burden of COVID-19 mortality is higher in counties with high proportions of Black residents,” wrote study coauthors, noting that percent of Black residents in a county is only a predictor of COVID-19 mortality in counties with higher degrees of SDoH.

“This precludes genetic differences as a possible explanation for COVID-19 racial disparities and challenges the harmful belief that racial disparities in illness primarily have a biological basis. Overall, this study provides both qualitative and quantitative evidence that SDH play a significant role in influencing increased COVID-19 mortality for Black Americans.”