{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:08:16Z","timestamp":1791515296921,"version":"4.3.4"},"reference-count":80,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate patient characteristics associated with HRSN screening completion, positivity, and assistance requests.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Patient sociodemographic characteristics.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 1\u202f893\u202f331 eligible adults, 696\u202f925 (36.8%) were 65 years or older (median age, 57 [IQR, 38-71] years), 1\u202f138\u202f792 (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\u202f449 (48.4%) had Medicare or Medicaid coverage. A total of 1\u202f135\u202f136 participants (60.0%) completed screening and 334\u202f399 (29.5%) reported at least 1 HRSN. Unadjusted differences between screened and unscreened patients were not significant (standardized mean difference, \u22640.20). 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.26901","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:00:30Z","timestamp":1785855630000},"page":"e2626901","source":"Crossref","is-referenced-by-count":2,"title":["Epidemiology of Health-Related Social Needs Screening and Positivity in a Multistate Health System"],"prefix":"10.1001","volume":"9","author":[{"given":"Bhavik P.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"},{"name":"Palliative and Advanced Illness Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"},{"name":"Leonard Davis Institute of Health Economics, Perelman School of 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