Studies also show that the effect of social risk factors on health is cumulative such that patients who experience more social risk factors have poorer health-related quality of life. Although low educational attainment, specifically, not completing high school, is known to lead to poor health and possible premature death; little is known about the association between low educational attainment and other social risk factors that can impact health. We identified and compared the prevalence of social risk factors in patients with less than high school education and patients with high school education or greater to determine what factors may be further contributing to poor health outcomes in patients with low educational attainment.

We reviewed results from social determinants of health screenings performed from October 2021 to October 2023 at a primary care clinic in Hartford, Connecticut. We compared the prevalence of social risk factors among patients who did and did not complete high school using Chi-square test of independence (p <0.05).

Volunteers screened 2,153 patients, 386 (17.9%) of whom did not complete high school. Compared to patients with high school education or greater, patients with less than high school education had a higher prevalence of unemployment (17.4% v. 13.4%, p=0.041), food insecurity (15.5% v. 9.8%, p=.0067), difficulty affording utilities (16.9% v. 9.8%, p=.0001), lack of transportation (30.8% v. 14.8%, p<0.001), and difficulty accessing healthcare/medication (5.1% v. 2.4%, p=0.007). The two groups had a similar prevalence of homelessness (9.0% v. 6.7%, p =0.17).

Our results show that failing to complete high school is associated with a higher prevalence of numerous social risk factors. Independently low educational attainment and the individual risk factors we investigated negatively impact health, but together their effects can compound and contribute to further worsening health outcomes. These findings argue that patients with low educational attainment should be routinely screened for social risk factors so, all factors that negatively impact their health can be identified and addressed.