Using GIS to Evaluate the Social Determinants of Health Michael Dulin

Disclosures I have no relationships to disclose. I will not discuss off label use and/or investigational use in my presentation. Funding from: – NIH (R01 MD006127) – The Robert Wood Johnson Foundation – NIH (R24 MD004930)

Background

Goal Examine the relationship between social determinants and health outcomes Design and validate GIS models that can identify areas within our community in need of health resources Implement community-based interventions to improve appropriate healthcare utilization

Community-Based Participatory Research Community Advisory Board (CAB) CAB Research Team Latino Community Healthcare Providers

Community Advisory Board (CAB) Healthcare System (Providers, Administrators) School Board City/County Management Parks Department Law Enforcement Community Academic (Social Sciences, Statistical Support, GIS) Health Department

Variables Race / Ethnicity Income Access to Grocery Stores Distance to Green Space Access to Public Transportation Access to Healthcare Social Network Hospitalizations ED Visits Primary Care Treatable ED Visits Utilization of Primary Care Quality of Life

Variable Selection Process Key Actors CAB Research Team Latino Community & Healthcare Providers Survey

Themes Identified / Data Elements Selected Education – Hispanic Population Speaking Spanish at Home and Not Proficient in English Economic Status - Hispanic/Latino Families below the Poverty Line Acculturation - Time of Arrival/Latin American-born Population who Entered U.S. in 2000 or Later and are Not U.S. Citizens Safety - Violent Crime Rate

Percent Hispanic (2010)

Access to Public Transportation

Violent Crime Rate

Emergency Department for Primary Care

Latin American Born Population who Entered the US after 2000 and not US Citizens

Hispanic Renter-Occupied Housing

Hispanic Hospitalization Rate

Median Household Income

Hispanic Children Speaking Spanish at Home - Not Proficient in English

Hispanic Families below the Poverty Line

Hispanic Patients Using a Safety Net Clinic

Hispanic Families

Hispanic High School Graduation Rate

Hispanic Population that Moved from Abroad in the Past Year

Hispanic Single Mother Families

Hispanic Unemployment Rate

Latin American-Born Population

Latin American-Born Population that Entered the U.S. in 2000 or Later

Latin American-Born Population who are not U.S. Citizens

Combining Variables Variables Identified are Normalized CAB asked to Weigh Each Variable Variables are combined CAB Adds Exclusion Criteria Composite Map Created Dulin MF, et. al. Geographic Information Systems (GIS) demonstrating primary care needs for a transitioning Hispanic community. J Am Board Fam Med Jan-Feb;23(1): Dulin MF, et. al. Using Geographic Information Systems (GIS) to understand a community’s primary care needs. J Am Board Fam Med Jan-Feb;23(1):13-21

Composite Map

Neighborhood Evaluation / Ground Truthing Drill Down to the Neighborhood Level Validation Process Started Qualitative / Photovoice Quantitative Begin to Build Intervention Team