• Kevin H Nguyen and Megan B Cole.
• Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts. Electronic address: nguyen@bu.edu.
• Am J Prev Med. 2025 Jan 1; 68 (1): 145153145-153.

IntroductionSocial risk factors are associated with worse access to care. This study measured the prevalence of social risk factors among low-income adults, assessed the relationship between number of social risk factors and access to care, and examined heterogeneity by health insurance type.MethodsUsing 2022 Behavioral Risk Factor Surveillance Survey data from 39 states, the association between number of SRFs (0, 1, 2-3, 4, or more) and three access to care measures (having a personal doctor, having a routine checkup, and inability to see doctor because of cost) were measured using multivariable linear probability models. The analysis was stratified by health insurance coverage type (private, Medicare, Medicaid, or uninsured) to assess whether effects were differential. Analyses were conducted in 2024.ResultsAmong 90,208 low-income adults, 46.6% reported at least one SRF. Compared to people who reported no SRFs, those who reported four or more were more likely to report being unable to afford care (28.21 percentage points [PP], p<0.001) and less likely to have a personal doctor (-4.98 PP, p<0.001) or routine checkup in the last two years (-4.29 PP, p<0.001). The magnitude of disparity by number of SRFs in inability to afford care was larger among privately insured and uninsured people compared to those with Medicare or Medicaid coverage.ConclusionsHigher levels of SRFs were associated with worse access to care among low-income adults. Policies that minimize cost-related barriers to care, coupled with care delivery reforms and social policies that address SRFs, may improve access to care.Copyright © 2024 Elsevier Inc. All rights reserved.

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