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Life sciences · Journal article
JAMA Network Open · August 4, 2026
Well-designed and adequately powered for the question it asks.
This large retrospective cohort study documents substantial selection biases and disparities in health-related social needs screening and burden across a 22-state health system. Black patients and Medicaid beneficiaries experienced lower screening odds in outpatient but not inpatient settings, yet reported higher HRSN positivity and burden when screened, indicating both access gaps and real need concentration in vulnerable populations.
Retrospective cohort study. Adults with screening-eligible outpatient or inpatient encounters in a 22-state, 92-hospital health system; median age 57 (IQR 38–71) years; 60.1% female; 13.6% Black, 3.2% Asian, 0.4% American Indian or Alaska Native, 0.2% Native Hawaiian or Other Pacific Islander, 82.5% White; 4.6% Hispanic or La…. Intervention: Patient sociodemographic characteristics (exposure variable, not a treatment). Compared with: Comparison across racial/ethnic groups and insurance types; White and commercially insured patients as reference groups. n = 1,893,331. 22-state health system with 92 hospitals.
Screening completion rate was 60.0% (1,135,136/1,893,331 eligible adults) Among screened participants, 29.5% (334,399) reported at least one HRSN Black patients had lower outpatient screening odds (OR 0.85, 95% CI 0.79–0.91) but 12.6% higher adjusted probability of any positive screen (ARD, 95% CI 9.5%–15.7%)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and health systems should recognize that HRSN screening completion is subject to racial and insurance-based disparities, particularly in outpatient settings, despite low overall selection bias. The higher burden of social needs in Black and Medicaid-insured patients justifies expanded inpatient screening workflows and targeted assistance programs to address documented inequities.
Large retrospective cohort study (1.9M adults) across 92 hospitals with rigorous adjusted analyses identifying screening disparities and HRSN burden by race, ethnicity, and insurance; provides clear epidemiological evidence but is observational and does not test an intervention.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and health systems should recognize that HRSN screening completion is subject to racial and insurance-based disparities, particularly in outpatient settings, despite low overall selection bias. The higher burden of social needs in Black and Medicaid-insured patients justifies expanded inpatient screening workflows and targeted assistance programs to address documented inequities.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Importance: Health systems increasingly screen for health-related social needs (HRSNs), which are modifiable social factors associated with health outcomes. However, screening selection biases and HRSN burdens are poorly characterized. Objective: To evaluate patient characteristics associated with HRSN screening completion, positivity, and assistance requests. Design, Setting, and Participants: This retrospective cohort study of adults with screening-eligible outpatient or inpatient encounters in a 22-state, 92-hospital system was performed from January 1, 2020, to November 30, 2024. Data were analyzed from June 7, 2025, to February 4, 2026. Exposure: Patient sociodemographic characteristics. Main Outcomes and Measures: Unadjusted standardized mean differences and adjusted logistic regression were used to identify characteristics associated with screening completion. Multivariable regression and marginal standardization were used to identify characteristics associated with positivity for any HRSN, total HRSN burden, and assistance requests. Results: Among 1 893 331 eligible adults, 696 925 (36.8%) were 65 years or older (median age, 57 [IQR, 38-71] years), 1 138 792 (60.1%) were female, 8437 (0.4%) were American Indian or Alaska Native, 60 884 (3.2%) were Asian, 257 391 (13.6%) were Black, 4193 (0.2%) were Native Hawaiian or Other Pacific Islander, and 1 561 702 (82.5%) were White; 87 641 (4.6%) were of Hispanic or Latino ethnicity, and 916 449 (48.4%) had Medicare or Medicaid coverage. A total of 1 135 136 participants (60.0%) completed screening and 334 399 (29.5%) reported at least 1 HRSN. Unadjusted differences between screened and unscreened patients were not significant (standardized mean difference, ≤0.20). In adjusted analyses, Black patients (odds ratio [OR], 0.85; 95% CI, 0.79-0.91) and Medicaid beneficiaries (OR, 0.87; 95% CI, 0.80-0.95) had lower odds of being screened, and Hispanic or Latino patients had higher odds (OR, 1.11; 95% CI, 1.01-1.23). Outpatient underscreening was attenuated in inpatient settings for Black patients and Medicaid beneficiaries. The adjusted probabilities of any positive screen were higher among Black (absolute risk difference [ARD], 12.6%; 95% CI, 9.5%-15.7%), American Indian or Alaska Native (ARD, 10.6%; 95% CI, 9.2%-11.9%), and Native Hawaiian or Other Pacific Islander (ARD, 7.2%; 95% CI, 2.1%-12.2%) patients and among Medicare (ARD, 13.1%; 95% CI, 9.7%-16.5%) and Medicaid (ARD, 18.7%; 95% CI, 16.1%-21.2%) beneficiaries compared with White and commercially insured patients. Black patients (ARD, 9.4%; 95% CI, 6.5%-12.3%) and Medicaid beneficiaries (ARD, 16.9%; 95% CI, 16.0%-17.9%) had higher adjusted probabilities of at least 3 positive domains. Among those with at least 3 positive domains, Black patients (ARD, 21.9%; 95% CI, 16.5%-27.2%), Medicare (ARD, 7.0%; 95% CI, 5.1%-8.8%), and Medicaid (ARD, 12.2%; 95% CI, 10.9%-13.6%) beneficiaries had higher assistance requests. Conclusions and Relevance: In this cohort study across inpatient and outpatient settings, HRSN screening had a substantial reach largely free of selection. Nearly 30% of screened patients demonstrated needs, with higher rates among patients who were members of racial and ethnic minority groups and publicly insured. This study provides support for inpatient HRSN screening workflows, even as policy mandates evolve, to preserve equitable reach for patient groups with disproportionately high social needs.
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