Characterizing Social Insecurity in a Rural North Carolina Emergency Department

Introduction: Social insecurity, a form of deprivation of social amenities, if present among patients presenting in a rural emergency department (ED) can be a source of medical burden and poor health outcomes. Although knowledge and understanding of the insecurity profile of such patients is necessary for targeted care that improves their health outcomes, the concept has not been comprehensively quantified. In this study we explored, characterized, and quantified the social insecurity profile of ED patients at a rural teaching hospital in southeastern North Carolina with a large Native American population. Methods: A paper survey questionnaire was administered by trained research assistants between May–June 2018 to patients who presented to the ED and consented to participate in this cross-sectional, single-center study. The survey was anonymous with no identifying information collected on the respondents. A general demographic section and questions derived from the literature capturing sub-constructs of social insecurity—communication access, access to transportation, housing insecurity and home environment, food insecurity, and exposure to violence–were captured in the survey. We assessed the factors included in the index of social insecurity based on a rank ordering using the magnitude of their coefficient of variation and the Cronbach’s alpha reliability index of the constituent items. Results: Overall, we collected 312 surveys from the approximately 445 administered and included them in the analysis, representing a response rate of about 70%. The average age of the 312 respondents was 45.1 (±17.7) years with a range of 18.0–96.0. More females (54.2%) than males participated in the survey. Native Americans (34.3%), Blacks (33.7%), and Whites (27.6%) comprised the three major racial/ethnicity groups of the sample, which are representative of the study area’s population distribution. Social insecurity was observed among this population regarding all the subdomains and an overall measure (P