Background Regulatory bodies such as the Joint Commission, have required health systems to screen patients for health-related social needs (HRSNs) to address social determinants of health (SDH), which influence individual and community health outcomes. Key screenings include housing instability, food insecurity, and transportation instability. Despite these efforts, there remains a gap in understanding the interconnections between various HRSNs. Addressing this gap is crucial for developing comprehensive interventions that target multiple SDH. This study aims to characterize the associations between key HRSNs.

Methods This prospective cross-sectional study at an adult urban primary care clinic from October 2021 through October 2023 saw volunteers screen patients for HRSNs: food insecurity; unemployment; less than high school education; housing instability; difficulty affording medications; and lack of access to transportation, utilities, phone, and medicine or any healthcare. Binary logistic regression determined associations between demographic factors: race, ethnicity, gender, and age and the HRSNs examined. Pearson correlation coefficients assessed linear relationships between HRSNs.

Results Volunteers screened 2153 patients identifying 49.34% with at least one HRSN. Binary logistic regression revealed no significant association between HRSNs and patient age (p=0.260), race (p=0.889, p=0.875), Hispanic ethnicity (p=0.652), gender (p=0.319). Pearson correlation coefficients identified significant associations: strong between food insecurity and difficulty affording utilities (r=0.447); moderate between food insecurity and difficulty accessing transportation (r=0.22), phone (r=0.286), and medicine or any healthcare (r=0.313). Housing insecurity correlated with transportation issues (r=0.200) and difficulty affording utilities with difficulty accessing medicine or any healthcare (r=0.306). A strong correlation was found between difficulty accessing medicine or any healthcare and affording medications (r=0.694).

Conclusion Our results reveal significant relationships among HRSNs, indicating interconnected challenges. Food insecurity positively correlates with 4 HRSNs, all of which can impact a patient’s overall health. Although studies that examine screening for food insecurity have not shown improved outcomes, interventions addressing SDH through housing or income support have proven beneficial. Targeted interventions for the HRSNs experienced by food insecure patients may prove valuable. Other associations support the need for comprehensive interventions. The link between medicine/healthcare access and affordability as well as housing instability and transportation issues underscores the interconnected challenges and the importance of integrated solutions. These findings suggest that HRSNs rarely exist in isolation, illustrating the need for multi-faceted interventions to effectively meet needs and improve outcomes of vulnerable populations.