Chronic disease management is a key aspect of providing value-based healthcare. Health plans and providers must address the root causes of chronic illness to minimize its impact. This means recognizing and addressing the critical role that social determinants of health (SDOH) play in overall health. Differences in SDOH contribute to the chronic disease disparities in the United States among different racial, ethnic, and socioeconomic groups by limiting the opportunities they have to be healthy.

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Social determinants strongly linked to the onset of chronic disease

The development of chronic diseases such as diabetes and heart disease is closely associated with the environments and behaviors surrounding individuals. For many people, especially those at greater risk of developing chronic disease, healthcare that begins and ends in traditional healthcare settings is insufficient to meet their needs. Acknowledging the SDOH that impacts chronic disease is crucial to care management.

A recent study by the National Academy of Medicine (NAM) saw an association between an increasing number of SDOH and an increased likelihood of chronic disease [1]. The results showed that the social and behavioral factors of having less than a high school education level, being widowed, concentrated neighborhood poverty, infrequent exercise, and smoking were significantly associated with hypertension onset. The researchers also found that the study’s non-white racial and ethnic groups had a higher risk of developing hypertension and diabetes than white individuals.

Key SDOH impacting chronic disease management

SDOH creates challenges contributing to worse health outcomes and more significant healthcare costs. Some of the critical SDOH that impact the management of chronic disease include:


The geographic location of an individual is a central SDOH, playing a crucial role in factors such as education level, housing security, public safety, and frequently income. Additionally, geography can limit a person’s access to care, significantly impacting their health. For example, people in more rural areas may live far away from medical facilities or have limited access to the services or providers they need. Physician shortages in certain areas can mean longer waiting times and delayed care. Inconsistent healthcare access may lead people to delay or skip medications, miss or reschedule appointments, and postpone crucial preventive care, resulting in worse health outcomes.

Socioeconomic status

Income is another critical SDOH with a far-reaching impact on health outcomes and overall wellness. An individual’s socioeconomic status has many secondary effects on things like geographic location, education level, housing and food security, and more. These socioeconomic factors directly affect patient health and chronic disease management since they can determine whether a person can afford to engage in healthcare. In 2022, about four in ten U.S. adults said they have delayed or gone without medical care in the last year due to cost [2]. This can result in people skipping medical appointments and treatments or poorly adhering to chronic disease care plans, ultimately hurting health outcomes.

Educational attainment and health literacy

An individual’s level of educational attainment is also associated with their well-being. Typically, people with higher levels of education tend to live healthier and subsequently longer lives. This difference in health outcomes can be attributed to a person's level of health literacy since patients with low health literacy may not understand their chronic care management plans. They may also have difficulty navigating the healthcare industry and not engage as actively in their care management plans.

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How at-home testing can help address SDOH and combat chronic disease

At-home testing can help the healthcare industry address the key SDOH that affects chronic disease management. Leveraging convenient and easy-to-use testing that meets people where they are can narrow disparities across many chronic diseases by removing inequitable barriers to good health. LetsGetChecked’s at-home tests can help health plans, and providers extend their reach beyond the confines of the traditional clinical setting and connect with patients wherever they call home. By addressing SDOH, we can make progress toward health equity and ensure that every person has the opportunity to reach their highest level of health.

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