More than 1 in 10 patients at federally qualified health centers experience major social risk factors

A first-of-its-kind study found high rates of food insecurity, housing insecurity, financial strain and a lack of transportation among FQHC patients, particularly those from low-income or marginalized populations.

PROVIDENCE, R.I. [Brown University] — Federally qualified health centers offer primary care services to 30 million individuals in the U.S., the majority of whom are low-income and/or underinsured and may not otherwise receive such care. While prior research has shown that 70% of FQHCs screen for social risk factors like food and housing insecurity, no studies have quantified the extent to which their patients are experiencing these challenges nationwide.

For the first time, a study by researchers at Boston University and Brown University obtained data from all federally qualified health centers that reported positive screening rates of food insecurity, housing insecurity, financial strain and lack of transportation, and found that more than one in 10 patients reported experiencing at least one of these social risk factors in 2022. 

Published in JAMA Internal Medicine, the findings also showed that rates of these risk factors were significantly higher among FQHCs with greater proportions of patients from historically disenfranchised groups.

“Federally qualified health centers are crucial safety-net providers for millions of low-income families in the U.S.,” said lead study author Kevin Nguyen, an assistant professor of health law, policy and management at Boston University’s School of Public Health who earned his Ph.D. from Brown. “In addition to delivering health services, these centers often provide assistance to patients seeking support for housing, food and transportation. Our findings likely reflect the structural barriers to equity that many patients from marginalized populations continue to face.”

For the study, Nguyen and colleagues at the Boston University School of Public Health and the Brown University School of Public Health used 2022 federal data from 1,338 FQHCs across the country, representing 30 million patients in total, including 21.7 million patients who reported positive screening rates.

Among the patients who were screened, the average positive rates were 27.6% for financial strain, 16.3% for food insecurity, 15.4% for housing insecurity and 14.1% for lack of transportation. Many who experienced some or all of the social risk factors also reported that they had income under the federal poverty level, lacked insurance, identified as Black, identified as a sexual minority, were currently or previously unhoused and/or lived in urban settings.

Nguyen and study author Megan Cole Brahim, an associate professor of health law, policy and management at Boston University, both earned doctoral degrees in health services research from Brown’s School of Public Health. A third author, Nicole Giron, is a current Ph.D. candidate in the same program at Brown.

“Federally qualified health centers do incredible work in service of their communities,” said Giron, whose dissertation will focus on these organizations. “Still, efforts to meet patients' social needs require significant resources to implement and sustain.”

The researchers hope their findings spur additional support for FQHCs, particularly those with more patients from marginalized backgrounds. Many FQHCs are experiencing several barriers to meeting the clinical and social needs of these patients, including limited training and limited ability to integrate screening into care processes. 

“Funding specifically allocated for integrating social risk screening, as well as community-informed processes for addressing unmet social needs, may help mitigate these barriers,” Nguyen said. “National policies are shifting toward incentivizing the measurement of social risk factors, so identifying the payment and care delivery models that equip providers to sustainably address unmet social needs among patients who want assistance may be critical.”

This story was adapted from news shared by the Boston University School of Public Health and authored by Jillian McKoy.