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Research ArticleOriginal Research

Health-Related Social Needs Following Onset of the COVID-19 Pandemic in Oregon

Jean Hiebert Larson, Anna L. Steeves-Reece, Zoe Major-McDowall, Bruce Goldberg and Anne King
The Annals of Family Medicine November 2024, 22 (6) 476-482; DOI: https://doi.org/10.1370/afm.3167
Jean Hiebert Larson
1Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
MS
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Anna L. Steeves-Reece
2OCHIN, Portland, Oregon
PhD, MPH
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Zoe Major-McDowall
1Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
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Bruce Goldberg
1Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
MD
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Anne King
1Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
MBA
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  • For correspondence: kinga@ohsu.edu
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  • Figure 1.
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    Figure 1.

    Change in the proportion of beneficiaries reporting HRSN, aggregated by week, before and after Oregon’s stay-at-home order.

    HRSN = health-related social needs.

    Notes: HRSN were reported between May 13, 2019 and December 24, 2021. The black line at March 23, 2020 marks the Oregon governor’s stay-at-home order (a proxy for the “intervention” of the COVID-19 pandemic in the model). The solid red lines indicate the lines of best fit before and after the order; the gray bands show the CIs for those lines. The broken red line is the counterfactual line (ie, expected trend if the pandemic had not happened).

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    Figure 2.

    Change in the proportion of beneficiaries reporting various types of HRSN, aggregated by week, before and after Oregon’s stay-at-home order.

    HRSN = health-related social needs.

    Notes: HRSN were reported between May 13, 2019 and December 24, 2021. The black line at March 23, 2020 marks the Oregon governor’s stay-at-home order (a proxy for the “intervention” of the COVID-19 pandemic in the model). The solid red lines indicate the lines of best fit before and after the order; the gray bands show the CIs for those lines. The broken red line is the counterfactual line (ie, expected trend if the pandemic had not happened).

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    Table 1.

    Participant Characteristics

    CharacteristicAll
    (N = 21,522)
    Relative to Stay-at-Home Ordera
    Before
    (n = 8,234)
    After
    (n = 13,288)
    P Value
    Age group, No. (%)<.001
        ≤17 years3,157 (15)1,375 (17)1,782 (13)
        18-64 years10,807 (50)3,199 (39)7,608 (57)
        ≥65 years7,558 (35)3,660 (44)3,898 (29)
    Gender, No. (%)<.001
        Female12,668 (59)5,154 (63)7,514 (57)
        Male8,202 (38)3,067 (37)5,135 (39)
        Unknown652 (3)13 (<1)639 (5)
    Residence, No. (%)<.001
        Urban13,711 (64)3,636 (44)10,075 (76)
        Rural7,453 (35)4,554 (55)2,899 (22)
        Frontier285 (1)11 (<1)274 (2)
        Unknown73 (<1)33 (<1)40 (<1)
    Medicaid beneficiary, No. (%)<.001
        Yes15,705 (73)5,391 (65)10,314 (78)
        No5,817 (27)2,843 (35)2,974 (22)
    Race, No. (%)<.001
        American Indian or Alaska Native ± White797 (4)329 (4)468 (4)
        Asian ± White370 (2)111 (1)259 (2)
        Black ± White1,056 (5)246 (3)810 (6)
        Native Hawaiian or other Pacific Islander ± White158 (1)37 (<1)121 (1)
        White only14,589 (68)6,318 (77)8,271 (62)
        Other only1,147 (5)250 (3)897 (7)
        Combination of ≥2 races not listed above290 (1)81 (1)209 (2)
        Unknown3,115 (14)862 (10)2,253 (17)
    Ethnicity, No. (%)<.001
        Hispanic or Latino/a/x3,181 (15)889 (11)2,292 (17)
        Not Hispanic or Latino/a/x14,854 (69)6,355 (77)8,499 (67)
        Unknown3,487 (16)990 (12)2,497 (19)
    • ↵a Before: the 1 year before the stay-at-home order. After: the 2 years after the stay-at-home order.

    • View popup
    Table 2.

    Changes in HRSN, Overall and by Type: Interrupted Time Series Models

    Model and Time PeriodaCoefficient Estimate (SE)95% CIt ValueP Value
    Primary model: overall HRSN
        Before  0.3974 (0.02011)  0.3576 to 0.437219.77<.001
        Trend before<0.0001 (0.00074)−0.0014 to 0.0015  0.05.96
        Stay-at-home order  0.1774 (0.02353)  0.1309 to 0.2240  7.54<.001
        Trend after  0.0006 (0.00079)−0.0021 to 0.0010−0.74.46
    Secondary models
    HRSN: food
        Before  0.2909 (0.01815)  0.2550 to 0.326816.03<.001
        Trend before−0.0007 (0.00067)−0.0021 to 0.0006−1.09.28
        Stay-at-home order  0.1651 (0.02125)  0.1231 to 0.2071  7.77<.001
        Trend after−0.0004 (0.00071)−0.0018 to 0.0010−0.55.58
    HRSN: housing
        Before  0.2131 (0.01824)  0.1771 to 0.249211.68<.001
        Trend before−0.0009 (0.00068)−0.0022 to 0.0004−1.34.18
        Stay-at-home order  0.1589 (0.02136)  0.1167 to 0.2011  7.44<.001
        Trend after  0.0013 (0.00072)−0.0001 to 0.0027  1.84.07
    HRSN: transportation
        Before  0.0916 (0.01536)  0.0612 to 0.1219  5.96<.001
        Trend before  0.0018 (0.00057)  0.0006 to 0.0029  3.09.002
        Stay-at-home order  0.0724 (0.01798)  0.0368 to 0.1080  4.03<.001
        Trend after−0.0024 (0.00060)−0.0035 to −0.0012−3.90<.001
    HRSN: utilities
        Before  0.0883 (0.01108)  0.0664 to 0.1102  7.97<.001
        Trend before  0.0003 (0.00041)−0.0005 to 0.0012  0.85.40
        Stay-at-home order  0.0746 (0.01297)  0.0490 to 0.0100  5.75<.001
        Trend after−0.0009 (0.00044)−0.0018 to −0.0001−2.12.04
    HRSN: interpersonal safety
        Before  0.0291 (0.00503)  0.0191 to 0.0390  5.78<.001
        Trend before−0.0003 (0.00019)−0.0006 to 0.0001−1.39.17
        Stay-at-home order  0.0442 (0.00589)  0.0326 to 0.0559  7.51<.001
        Trend after−0.0001 (0.00020)−0.0005 to 0.0002−0.62.54
    • HRSN= health-related social needs; SE = standard error.

    • ↵a Before: level before the stay-at-home order (intercept, time zero); trend before: change in slope in the 1 year before order; stay-at-home order: change in level at the time of the order; trend after: change in slope in the 2 years after order.

Additional Files

  • Figures
  • Tables
  • SUPPLEMENTAL DATA IN PDF FILE BELOW

    Supplemental Appendix. Statistical AnalysisSupplemental 

    Supplemental Table 1. Health-Related Social Needs (HRSN) Before and After Oregon's Stay-at-Home Order

    • KingSuppAppTable.pdf
  • VISUAL ABSTRACT IN PDF FILE BELOW

    • King.pdf
  • PLAIN-LANGUAGE ARTICLE SUMMARY

    Original Research

    Stay-at-Home Order Led to Increased Reporting of Health-Related Social Needs in Oregon 

     Background and Goal: Efforts to address the health-related social needs (HRSN) of Medicare and Medicaid beneficiaries, such as housing and food, during the COVID-19 pandemic were insufficient. This research examined HRSN data from the Accountable Health Communities (AHC) study collected in Oregon to understand changes in HRSN for Medicare and Medicaid beneficiaries at the onset and first two years of the pandemic.

     Study Approach: The study sample included 21,522 Medicare and Medicaid beneficiaries screened for overall health-related social needs between May 13, 2019 and December 24, 2021. An interrupted time series analysis was used to analyze both the immediate effects and the long-term trend changes in Medicare and Medicaid beneficiary reported HRSN following Oregon’s stay-at-home order.

     Main Results: A total of 21,522 unique Medicare and Medicaid beneficiaries participated in AHC in Oregon between May 13, 2019 and December 24, 2021: 8,234 before the March 23, 2020 stay-at-home order and 13,288 following it. The number of screens for any given week ranged from 34 to 385.

    • There was an abrupt 17.7  percentage point increase in overall health-related social needs around March 23, 2020 (onset of stay-at-home order) which did not significantly decline during the study period.

    • The percentage of beneficiaries reporting food, housing, and interpersonal safety needs increased by 16.5, 15.9, and 4.4 percentage points, respectively, with no significant decline during the study period.

    • The percentage of beneficiaries reporting transportation and utility needs increased by 7.5 and 7.2 percentage points, respectively, but decreased significantly after the start of the pandemic (decreasing by 0.2 and 0.1 percentage points each week, respectively).

    Why It Matters: The jump in the number of people reporting health-related social needs following the start of the pandemic and the persistence of needs, particularly in housing, point to a need for increased understanding of which public health and health care interventions, investments, and policies effectively address health-related social needs. Public investments in social service delivery systems, and population-specific actions by payers and clinical systems may be effective strategies to address the health-related social needs of Medicare and Medicaid beneficiaries.

    Health-Related Social Needs Following Onset of the COVID-19 Pandemic in Oregon

    Anne King, MBA, et al

     Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon

    Visual Abstract


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The Annals of Family Medicine: 22 (6)
The Annals of Family Medicine: 22 (6)
Vol. 22, Issue 6
November/December 2024
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Health-Related Social Needs Following Onset of the COVID-19 Pandemic in Oregon
Jean Hiebert Larson, Anna L. Steeves-Reece, Zoe Major-McDowall, Bruce Goldberg, Anne King
The Annals of Family Medicine Nov 2024, 22 (6) 476-482; DOI: 10.1370/afm.3167

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Health-Related Social Needs Following Onset of the COVID-19 Pandemic in Oregon
Jean Hiebert Larson, Anna L. Steeves-Reece, Zoe Major-McDowall, Bruce Goldberg, Anne King
The Annals of Family Medicine Nov 2024, 22 (6) 476-482; DOI: 10.1370/afm.3167
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