• Erika M Brown, Stephanie M Franklin, Jessica L Ryan, Melanie Canterberry, Andy Bowe, Matt S Pantell, Erika K Cottrell, and Laura M Gottlieb.
• California Policy Lab, Institute for Research on Labor and Employment, University of California, Berkeley, Berkeley, California; Social Interventions Research & Evaluation Network, University of California San Francisco, San Francisco, California. Electronic address: erika.brown@berkeley.edu.
• Am J Prev Med. 2023 Dec 1; 65 (6): 116311711163-1171.

IntroductionConcerns about the opportunity costs of social screening initiatives have led some healthcare organizations to consider using social deprivation indices (area-level social risks) as proxies for self-reported needs (individual-level social risks). Yet, little is known about the effectiveness of such substitutions across different populations.MethodsThis analysis explores how well the highest quartile (cold spot) of three different area-level social risk measures-the Social Deprivation Index, Area Deprivation Index, and Neighborhood Stress Score-corresponds with six individual-level social risks and three risk combinations among a national sample of Medicare Advantage members (N=77,503). Data were derived from area-level measures and cross-sectional survey data collected between October 2019 and February 2020. Agreement between individual and individual-level social risks, sensitivity values, specificity values, positive predictive values, and negative predictive values was calculated for all measures in summer/fall 2022.ResultsAgreement between area and individual-level social risks ranged from 53% to 77%. Sensitivity for each risk and risk category never exceeded 42%; specificity values ranged from 62% to 87%. Positive predictive values ranged from 8% to 70%, and negative predictive values ranged from 48% to 93%. There were modest performance discrepancies across area-level measures.ConclusionsThese findings provide additional evidence that area-level deprivation indices may be inconsistent indicators of individual-level social risks, supporting policy efforts to promote individual-level social screening programs in healthcare settings.Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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