# A comparison of social drivers of health identification and intervention rates by sex among patients receiving primary care

## TL;DR

This study finds sex-based differences in social drivers of health among primary care patients, suggesting the need for gender-responsive interventions to improve health equity.

## Contribution

The study identifies sex-specific disparities in social drivers of health using a large primary care dataset, highlighting the need for tailored interventions.

## Key findings

- Females reported higher rates of financial strain, food insecurity, and mental health risks compared to males.
- Males had higher rates of alcohol and tobacco use, with White/Caucasian males showing the highest alcohol use.
- Despite similar overall rates of unmet SDOH needs, sex differences in specific domains suggest distinct challenges for men and women.

## Abstract

Social drivers of health (SDOH) significantly influence health behaviors and outcomes, yet sex-based disparities in these domains remain underexplored. Identifying these differences is essential for guiding equitable, evidence-based interventions.

We analyzed electronic health record (EHR) data from all patients with a documented male or female sex who had a primary care visit or inpatient stay at the Medical University of South Carolina (MUSC) between January 1, 2023, and December 31, 2024 (n = 493,920). SDOH screening responses were categorized as “affirmative” (at risk) or “negative” (not at risk) across 17 predefined domains using Epic’s logic-based risk classification. Descriptive statistics were calculated, and z-tests for proportions were used to assess sex-based differences. Race and ethnicity were included as descriptive variables; no inferential tests by race/ethnicity were conducted.

Females were significantly more likely to report financial strain (7.96%), food insecurity (4.44%), housing instability (3.72%), intimate partner violence (2.03%), transportation barriers (2.20%), depression (3.93%), and stress (14.10%). Despite these risks, females also reported higher rates of protective behaviors such as physical activity (74.2%) and social connectedness (14.22%). In contrast, males had higher rates of alcohol use (4.67%), tobacco use (35.6%), and adolescent substance use (2.14%). Notably, White/Caucasian males reported the highest alcohol use (6.23%), and both White and Black males reported the highest tobacco use (42%).

Sex-based disparities in SDOH reflect broader structural and social inequities. Health systems should implement routine, EHR-integrated SDOH screening and use this data to inform tailored, gender-responsive interventions—such as increasing access to mental health support for women and addressing substance use among men—while also considering how intersecting factors like race, income, and caregiving burden compound these risks.

Social Drivers of Health (SDOH), such as access to housing, food, and financial resources, can impact overall well-being and health outcomes. This study examined gender differences in SDOH by analyzing responses across different domains among a sample of individuals who received primary care at a regional health system in the Southeastern United States. While males and females had similar overall rates of positive responses (69% for both groups), there were significant differences when looking at individual domains. These findings suggest that males and females may experience different challenges related to SDOH, which could impact their ability to access resources and support services. Understanding these differences can help shape policies and programs that better address the unique needs of both men and women, ultimately improving health equity.

This study examined sex differences in key social drivers of health (SDOH) needs among a large sample of individuals receiving care at an academic medical center in the southeastern U.S.Both males and females had nearly identical overall rates of reported unmet SDOH needs, with approximately 69% reporting at least one need.Despite similar overall rates, significant sex differences emerged across specific SDOH domains, highlighting distinct challenges faced by men and women.Identifying these sex-specific differences in SDOH needs can help tailor interventions and policies to better support individuals in accessing necessary resources and services.

This study examined sex differences in key social drivers of health (SDOH) needs among a large sample of individuals receiving care at an academic medical center in the southeastern U.S.

Both males and females had nearly identical overall rates of reported unmet SDOH needs, with approximately 69% reporting at least one need.

Despite similar overall rates, significant sex differences emerged across specific SDOH domains, highlighting distinct challenges faced by men and women.

Identifying these sex-specific differences in SDOH needs can help tailor interventions and policies to better support individuals in accessing necessary resources and services.