OBJECTIVES: Social determinants of health (SDoH) burden has been correlated with disparities in care access and risk of health issues. Using self-reported information about economic security captured in the electronic health record (EHR), we investigated the hypothesis that insecurity would be associated with higher utilization and chronic disease prevalence.

METHODS: We analyzed clinical data for patients from a large Midwest health system in the OMNY Health real-world data platform who were systematically asked “How hard is it to pay for the very basics like food, housing, medical care, and heating?” in a 2022 SDoH survey. We defined economic insecurity as responding: “somewhat hard”, “hard”, or “very hard.” Using 2022-2023 EHR data, we compared differences in demographic characteristics, average number of encounters by type, and frequency of 7 common chronic conditions by economic security status.

RESULTS: Responses from 362,946 patients were included; 18,300 (5.0%) reported economic insecurity. Patients with insecurity were more likely to be female (62% vs. 58%), black (20% vs. 11%), and unemployed (26% vs. 15%). Insecure patients had higher rates of type 2 diabetes (24% vs. 18%) and chronic lung disease (22% vs. 13%); no notable differences were observed for heart disease, cancer, stroke, Alzheimer’s disease, or chronic kidney disease. Insecure patients had greater healthcare utilization with a higher average number of inpatient (0.47 vs. 0.22), outpatient (6.77 vs. 5.23), and emergency room (1.42 vs. 0.67) visits during the two-year period.

CONCLUSIONS: Patients reporting economic insecurity were more likely to be black or unemployed, have more visits across all healthcare settings, and exhibit higher chronic disease burden. The availability of SDoH survey data will likely increase in response to changing national reporting requirements and EHR capabilities. Future research will examine the causal and temporal relationship between changes in economic security, utilization, and chronic disease management.