How Common Are Social Determinants of Health? A Comparison of National Estimates and Health System-Reported Prevalence.

Abstract

Social Determinants of Health (SDOH) play a critical role in shaping health outcomes and utilization. Although national surveys demonstrate high prevalence of social needs, many health systems rely on brief clinical screening tools to assess their local SDOH concerns. This study analyzed adult patients who completed an SDOH questionnaire within Meritus Health, a regional integrated health system in Western Maryland, between January and December 2024. Patient-reported prevalence across 6 SDOH domains (food insecurity, loneliness, financial insecurity, health literacy, transportation insecurity, and housing insecurity) was compared with published national prevalence estimates. Reported SDOH prevalence within the health system was consistently lower than national benchmarks, ranging from 3.5% to 7.9%. Assuming that national estimates are more representative of the population, these findings suggest that brief, portal-based clinical screening may underestimate true social need due to screening tool differences, population differences, contextual underreporting, and geographic variation.