The Impact of Community-Level Socioeconomic Deprivation and Residential Stability on Healthcare Access and Service Utilization Among Individuals with Mental Illness

Background and Purpose: People with mental illness (MI) have up to 33% lower life expectancy compared to the general population due, in large part, to a high prevalence of comorbidities including diabetes, obesity, cardiovascular disease, cancer, and substance use disorders. Efforts to improve healthcare outcomes among this population have mostly targeted individual- and systems-level factors such as impaired cognition, self-efficacy, and care coordination. Yet, disparities in health and healthcare outcomes for individuals with MI persist. Social and economic aspects of communities also impact the health of people with mental illness. This abstract will examine how community-level factors influence healthcare access among individuals with mental illness.

Methods: A national sample of people with mental illness (N=5,444) was established using data from the Medical Expenditure Panel Survey (MEPS; 2013-2017). Mental health (MH) diagnoses included schizophrenia and psychotic disorder, bipolar disorder, and depressive disorders. The Area Deprivation Index (ADI) and an indicator of Residential Stability were used in unadjusted and adjusted logistic regression models to examine the impact of these community-level variables on physical and mental healthcare access and service utilization outcomes.

Results: In unadjusted analyses, higher ADI (i.e., higher levels of socioeconomic deprivation) was associated with lower odds of having a usual source of care (OR = 0.96, p < .001), higher odds of forgoing needed care and prescription medication (ORs = 1.07, p < .01) and delaying prescription medication (OR = 1.04, p < .05). Higher ADI was also associated with increased inpatient care use for both MH and general health (ORs = 1.11 and 1.06, p < .05) and ER use for general health (OR = 1.10, p < .001). Higher residential stability was associated with increased odds of having a usual source of care (OR = 1.21, p < .001) and lower odds of forgoing or delaying needed care (ORs = 0.88 and 0.89, p < .05) and foregoing needed medication (OR = 0.83, p < .01). In models that adjusted for individual-level demographic and clinical factors, higher ADI was associated with increased ER use (OR = 1.05, p < .01). Adjusted models also revealed that higher residential stability was associated with both increased odds of having a usual source of care (OR = 1.13, p < .05) and lower odds of forgoing needed medication (OR = 0.85, p < .05).

Conclusion and Implications: Findings show that the socioeconomic characteristics of communities increase reliance on inpatient and emergency care, while also negatively impacting pathways to preventative care among individuals with MI. Additionally, residential stability at the community level appears to promote access to healthcare among this population. Incorporating community-level factors into future mental health research could help target resources to communities with the greatest barriers to care and inform interventions that take a multidimensional approach to facilitating healthcare access for people with MI.