Prevalence of 19 Social Risks in a National Survey of Veterans Health Administration Patients.

BACKGROUND: Social risks (adverse social and economic conditions) exert greater impact on health than clinical care. The Veterans Health Administration (VA) conducts annual clinical screenings for food insecurity, housing insecurity, and intimate partner violence nationally, but less is known about the prevalence of a wider array of social risks among VA patients. OBJECTIVE: To quantify the prevalence of 19 social risks among VA patients. DESIGN: A cross-sectional survey, designed with VA operational leaders, clinicians, researchers, and Veterans, was distributed via web and mail March 21-June 25, 2024. PARTICIPANTS: National sample of 13,510 Veterans with ≥ 1 prior-year visit to VA primary and/or mental health care, stratified by health record-based age, race/ethnicity, and sex with oversampling for underrepresented groups.  MAIN MEASURES: Prevalence of 19 social risks across material (e.g., food insecurity), social (e.g., social support), and personal (e.g., health literacy) circumstances, weighted for sampling and non-response probabilities.  KEY RESULTS: Among 3430 respondents (response rate 25.4%), 53.1% (95% confidence interval (CI) 51.4-54.7%) were above age 65 years; 84.8% (95% CI 83.5-86.0%) were cisgender men; 18.2% (95% CI 16.9-19.5%) were Black or African American; and 9.3% (95% CI 8.3-10.3%) were Hispanic, Latino, or Spanish. Nearly all (93.8%, 95% CI 92.6-94.9%) reported ≥1 social risk. The five most prevalent experiences were social isolation (54.9%, 95% CI 52.7-57.1%), financial strain (49.4%, 95% CI 47.1-51.7%), discrimination (47.8%, 95% CI 45.6-49.9%), caregiver responsibilities (39.8%, 95% CI 37.5-42.1%), and low digital literacy (37.9%, 95% CI 35.8-40.2%). CONCLUSIONS: Nearly all VA patients experience one or more social risks, which can negatively impact health and pose barriers to care. None of the five most prevalent social risks is included in VA's current annual screenings. These findings can inform VA's ongoing efforts to identify social risks, tailor care, and offer social and financial services to improve Veterans' health and well-being.

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