Assessing the Health Impacts of Utility Disconnection Threats: Patient-Level Evidence from Cuyahoga County, OH

• In Event: Power, Heat, and Well-Being: Energy Access as a Social Determinant of Health

Abstract

Emerging research shows that energy insecurity, a household’s inability to meet basic energy needs, has significant health implications. Survey evidence indicates individuals facing energy insecurity are more likely to experience respiratory and cardiovascular conditions as well as mental health symptoms. Our study extends this work by analyzing patient-level data from The MetroHealth System in Cleveland, Ohio. MetroHealth is a public safety-net hospital and the largest provider of care to Medicaid and uninsured patients in Ohio, with over 1 million visits paid by Medicaid and uninsured patients in 2021, in Cleveland and Cuyahoga County, Ohio.

MetroHealth screens patients for social determinants of health (SDOH), including food, housing, and utility insecurity. We use these data to examine whether reported utility insecurity is associated with three healthcare utilization outcomes: 1) hospital and emergency room (ED) visits; 2) ambulatory visits for respiratory health; and 3) ambulatory visits for mental health. Patients are classified as utility insecure if, within the past 12 months, they were threatened with shutoff of electric, gas, oil, or water services. The screener also provides information on demographic characteristics (e.g., age, race/ethnicity), comorbidities (e.g., asthma, hypertension), housing quality issues (e.g., lack of heat, mold, pests), and health insurance coverage, allowing us to provide descriptive statistics of utility insecure individuals and adjust for a wide range of individual-level factors in empirical models.

We employ a longitudinal study design where SDOHs reported in 2021 were used to analyze patients’ health outcomes in 2022. We conducted bivariate analyses between utility insecurity and predictor variables, such as sociodemographic characteristics and comorbidities. Chi-square test was used to test association between the categorical variables. For multivariable analyses, we used negative binomial logistic regression models due to overdispersion of the health outcome data and adjusted for covariates listed above.

There were 14,333 patients in our sample. Majority were female (10,610 (74%)); and non-Hispanic, White 9,467 (66%)). Approximately 43% were on Commercial insurance, 33% on Medicare, and 18% on Medicaid. In 2021, 7.1% (n=1,023) patients were threatened with shut off by a utility provider, nearly 1% (n=102) lacked heat in their home, and 9.4%reported other housing quality issues. Bivariate analyses indicated that utility insecurity was significantly higher among Hispanic compared to non-Hispanic (11% vs. 7%); Black/African American compared to White population (14% vs. 4%); and Medicaid population compared to commercial (17% vs. 4.5%). Utility insecurity was associated with significantly higher comorbidities. In the multivariable analyses, utility insecurity is significantly and positively associated with adverse health outcomes. Specifically, patients reporting utility insecurity in 2021 had higher rates of ED visits [1.40 (95% CI: 1.23 – 1.60)] and ambulatory visits for mental health [1.40 (95% CI: 1.21 - 1.63)] in 2022.

Preliminary findings suggest MetroHealth patients who reported the threat of a utility disconnection in the previous year are likely to have poorer health outcomes. Health care providers and policymakers should consider targeted interventions to reduce negative health outcomes associated with utility shut off and energy insecurity in this vulnerable patient population.

Author

• Michelle Graff, Georgia Institute of Technology
  Presenting Author