Assessing Area-Level Deprivation as a Proxy for Individual-Level Social Risks

Introduction: Concerns about the opportunity costs of social screening initiatives have led some healthcare organizations to consider using social deprivation indices (area-level social risks) as proxies for self-reported needs (individual-level social risks). Yet, little is known about the effective-ness of such substitutions across different populations.Methods: This analysis explores how well the highest quartile (cold spot) of three different area -level social risk measures-the Social Deprivation Index, Area Deprivation Index, and Neighbor-hood Stress Score-corresponds with six individual-level social risks and three risk combinations among a national sample of Medicare Advantage members (N=77,503). Data were derived from area-level measures and cross-sectional survey data collected between October 2019 and February 2020. Agreement between individual and individual-level social risks, sensitivity values, specificity values, positive predictive values, and negative predictive values was calculated for all measures in summer/fall 2022.Results: Agreement between area and individual-level social risks ranged from 53% to 77%. Sensitivity for each risk and risk category never exceeded 42%; specificity values ranged from 62% to 87%. Positive predictive values ranged from 8% to 70%, and negative predictive values ranged from 48% to 93%. There were modest performance discrepancies across area-level measures.Conclusions: These findings provide additional evidence that area-level deprivation indices may be inconsistent indicators of individual-level social risks, supporting policy efforts to promote individual-level social screening programs in healthcare settings. Am J Prev Med 2023;65(6):1163-1171. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.