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-OccupiedHousing

Hispanic Hospitalization Rate

Median Household Income

Hispanic Children Speaking Spanish at Home - Not Proficient in English

Hispanic Families below thePoverty 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. 2010 Jan-Feb;23(1):109-20.

Dulin MF, et. al. Using Geographic Information Systems (GIS) to understand a community’s primary care needs. J Am Board Fam Med. 2010 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