SDH Community Phenotypes Map
Studies have consistently shown social determinants of health (SDH) to be significant factors shaping the health and longevity of individuals. Although SDH rarely exist in isolation, the body of literature regarding SDH largely examines the effects of individual SDH on communities. The objective of this study was to design a model that identifies community phenotypes based on combinations of co-existing SDH that span five categories outlined by Healthy People 2020: economic stability, education, health care, built environment, and social context. Our main data source was the U.S. Census American Community Survey from 2012-2016. We retrospectively compiled a database of SDH variables for all Virginia counties and cities. Each SDH was standardized and assigned a score: 5 for highest performers and 1 for lowest performers. The scores were sorted and averaged across the five categories and used as inputs for the cluster analysis. We used a two-step cluster analysis to reveal community phenotypes, and the resulting clusters were compared to each other and to demographic factors. The cluster analysis resulted in five phenotypes in Virginia, without any visible correlation to geographic location. Clusters A and C have low to median scores in all five SDH categories, Clusters B and D have different mixes of high and low scores, while Cluster E has generally high performance across all SDH categories. The clusters were found to be significantly different from each other based on SDH and demographic factors including age and foreign-born population. We concluded that social determinants of health exert their impact in the context of broader environmental and social factors. Characterizing the relationship between combinations of SDH and health outcomes may be the next step towards encouraging counties with similar profiles to collaborate to augment the influence of these SDH.