Social Determinants of Health Impact Severity of Chronic Disease

New Jersey’s poorest zip codes have the highest rates of individuals with chronic diseases seeking care in emergency rooms, showing a strong link between the social determinants of health and poor outcomes, according to a new state report.

The team from the Center for Health Analytics, Research and Transformation (CHART) at the New Jersey Hospital Association (NJHA) also found a clear relationship between employment status, income and nutrition, and poor health status.

Chronic diseases are on the rise in New Jersey, the report said, and the prevalence of these conditions is straining healthcare delivery across the state. To better understand the impact of chronic conditions on care delivery in New Jersey, the CHART team examined patient record data from more than three million hospital ER visits in 2017.

The results showed that hospitals in New Jersey spend over $2 billion each year providing emergency care to patients who don’t need to be admitted for more advanced treatment. Approximately 1.2 million, or 39 percent, of these visits were associated with patients who had one or more chronic conditions.

On average, these visits are 54 percent costlier than those associated with patients who had no chronic conditions.

“These are real, measurable impacts on our state,” said Sean Hopkins, Senior Vice President of CHART.

“But chronic diseases also have a myriad of additional consequences on individuals and communities that are more challenging to quantify. What we do know from our research is that there is a clear relationship between social determinants of health and chronic diseasecases in the ED.”

The results demonstrated that the three poorest counties in the state, including Cumberland, Essex, and Atlantic, exhibited the highest rates of chronic disease patients seeking care in hospital ERs. The statewide average use rate for ER visits for patients with chronic conditions is 129.62 per 1000 population.

Cumberland county’s use rate was almost double the statewide average, at 237.29, while Essex saw a rate of 166.0 and Atlantic had an ER usage rate of 202.15.

These findings demonstrate the critical role that non-clinical factors can play in a person’s overall health.

“While poor health habits such as lack of exercise, poor diet and smoking are a major contributor to the onset of chronic conditions, geographic location may also be a major factor,” the report said.

“A person’s zip code could be equally as important if not more important than one’s genetic code.”

Cumberland, Essex, and Atlantic counties also have three of the four highest unemployment rates in the state, the report pointed out. While the statewide unemployment average is 4.4 percent, the unemployment rate is 6.6 percent in Cumberland, 5.7 in Essex, and 5.4 percent in Atlantic.

These statistics reveal why chronic disease patients who live in these counties may experience higher rates of ER visits.

“You can live well with a chronic condition, but that requires access to primary care, a medical home and care management,” said NJHA President and CEO Cathy Bennett.

“CHART’s study zeroes in on hotspot zip codes where there are clear gaps in that level of care. These communities demand greater attention to make sure all individuals have access to the services they need.”

To reduce the burden of chronic conditions in underserved communities, CHART recommended that healthcare leaders partner to expand the availability of mobile health clinics, school-based chronic care management programs, and health fairs.

“Evidence suggests that mobile health clinics produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups,” the report said.

In addition, CHART suggested that leaders promote the use of chronic disease management apps and remote monitoring devices, as well as discuss new initiatives that will improve population health.

The negative effects of chronic disease are exacerbated in New Jersey’s lower-income communities, but action from healthcare leaders can help reduce these impacts.

“Chronic disease places an enormous financial strain on the healthcare delivery system, but more importantly, has a debilitating impact on quality of life for the residents of New Jersey,” the report concluded.

“Information contained in this study strongly illuminates the need for policy makers, healthcare providers, state public health agencies, other stakeholders and individuals themselves to take the necessary steps to effectively begin the process of mitigating and reducing the presence of chronic disease.”

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