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Leveraging Data and Digital Health Technologies to Assess and Impact Social Determinants of OJPHI

Health (SDoH): a State-of-the-Art Literature Review

Leveraging Data and Digital Health Technologies to Assess and

Impact Social Determinants of Health (SDoH): a State-of-the-
Art Literature Review
Kelly J. Thomas Craig, PhD1*, Nicole Fusco, ScD2, Thrudur Gunnarsdottir, PhD2, Luc
Chamberland, MA2, Jane L. Snowdon, PhD1, William J. Kassler, MD, MPH2,3.
1
IBM® Watson Health®, Center for AI, Research, and Evaluation, 75 Binney Street, Cambridge, MA,
02142 USA, 2IBM® Watson Health®, 75 Binney Street, Cambridge, MA, 02142 USA, 3 Palantir
Technologies, 1555 Blake Street, Denver, CO 80202

Abstract
Objective: Identify how novel datasets and digital health technology, including both analytics-based
and artificial intelligence (AI)-based tools, can be used to assess non-clinical, social determinants of
health (SDoH) for population health improvement.

Methods: A state-of-the-art literature review with systematic methods was performed on MEDLINE,
Embase, and the Cochrane Library databases and the grey literature to identify recently published
articles (2013-2018) for evidence-based qualitative synthesis. Following single review of titles and
abstracts, two independent reviewers assessed eligibility of full-texts using predefined criteria and
extracted data into predefined templates.

Results: The search yielded 2,714 unique database records of which 65 met inclusion criteria. Most
studies were conducted retrospectively in a United States community setting. Identity, behavioral,
and economic factors were frequently identified social determinants, due to reliance on
administrative data. Three main themes were identified: 1) improve access to data and technology
with policy – advance the standardization and interoperability of data, and expand consumer access
to digital health technologies; 2) leverage data aggregation – enrich SDoH insights using multiple data
sources, and use analytics-based and AI-based methods to aggregate data; and 3) use analytics-based
and AI-based methods to assess and address SDoH – retrieve SDoH in unstructured and structured
data, and provide contextual care management sights and community-level interventions.

Conclusions: If multiple datasets and advanced analytical technologies can be effectively integrated,
and consumers have access to and literacy of technology, more SDoH insights can be identified and
targeted to improve public health. This study identified examples of AI-based use cases in public
health informatics, and this literature is very limited.

Keywords: social determinants of health, artificial intelligence, digital health, data analytics, health
policy

Abbreviations: application programming interfaces (API), artificial intelligence (AI), electronic health
records (EHRs), machine learning (ML), natural language processing (NLP), return on investment (ROI),
social determinants of health (SDoH)

* Correspondence: [email protected]

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 13(3):e14, 2021
Leveraging Data and Digital Health Technologies to Assess and Impact Social Determinants of OJPHI
Health (SDoH): a State-of-the-Art Literature Review

DOI: 10.5210/ojphi.v13i3.11081

Copyright ©2021 the author(s)

This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics.
Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the
copy and the copy is used for educational, not-for-profit purposes.

Introduction
In the current clinical practice and policy environment, significant attention is focused on non-
clinical factors outside of the healthcare system that impact health outcomes. It is generally
acknowledged that healthcare alone accounts for only 10-25% of the variance of health outcomes
[1]. According to the County Health Rankings model, “modifiable contributions to health include
social and economic factors (40%), behavior (30%), clinical care (20%), and environmental factors
(10%)” [2]. These health factors are often collectively referred to as social determinants of health
(SDoH) even though these non-clinical determinants are not strictly social considerations [3]. Both
policymakers [4] and healthcare systems [5] have begun to recognize the importance of factors,
such as education, income, housing, food, and the built environment, to help improve health
outcomes, reduce disparities, and lower medical costs. Awareness is still required to promote the
widespread adoption of integrated healthcare and social services approaches, and long-term
investments are needed in the healthcare sector to facilitate referrals for services that address
SDoH. Common barriers to social services investments include perceived lack of short-term return
on investments, inability to identify and allocate costs to patient care, lack of coverage and
reimbursement by payers, and challenges in coordination, communication, and data fluidity
between medical and social organizations [6].

There is a paucity of evidence for prioritizing SDoH factors for intervention based on the financial
return on investment (ROI). Guidance from the National Academy of Medicine [7] and
recommendations provided by the World Health Organization [8] supports the premise that
actionable SDoH factors (i.e., those that lend themselves to direct action) will provide strong use
cases for integration of social services into ongoing operations. Optimal interventions will target
the community level to improve the underlying social and economic conditions contributing to
health disparities, rather than mediating individual needs alone [5]. The incorporation of non-
clinical support, such as providing food or housing, can improve health when applied on an
appropriate scale, but the financial aspects of integrating SDoH interventions remain a challenge.

Despite the financial challenges of integrating SDoH assessment and interventions into healthcare,
data and technology are being leveraged to improve both the identification of actionable SDoH
factors and population health. The transition to value-based care has promoted the development of
collaborative tools utilizing SDoH data and innovative technology to identify and stratify the
highest-risk individuals within a community. As the effort to gather SDoH data is prioritized,
digital health technologies can be foundational in the collection and assessment of SDoH data,
including development of novel sources of data and the platforms by which this information is
exchanged between stakeholders. Predictive analytics and other new methods of data analysis
including artificial intelligence (AI) can be important tools to identify, assess, and provide insights

to address SDoH and their associated health outcomes and related disparities, in order to improve
efficiencies in evaluation with the goal of improving care and lowering costs.

The objective of this study was to perform a state-of-the-art literature review to identify how SDoH
data and digital health technology are leveraged to improve population health management.
Studies of interest were those using large and innovative datasets in addition to studies employing
digital health technologies, including those with analytical-based and AI-based methods, to assess
and address SDoH factors as a strategy for population health improvement.

Methods
A state-of-the-art literature review with systematic methods was conducted [9]. Searches for all
relevant articles were conducted in MEDLINE via PubMed, the Cochrane Library, and Embase
according to the summative methods and search strategies outlined in Supplemental Tables 1-7. There
was a focus on non-clinical SDoH; health disparity; and health equity terms for our population of
interest. A manual search of the bibliographies of full-text articles pertinent to the review was also
conducted.

One reviewer screened titles and abstracts of articles identified by the literature searches to select
a list of articles to be considered as sources for the report. Two reviewers independently screened
all potential full-text citations to determine which sources were included using a priori criteria
(i.e., included articles must describe digital health technology or novel data used to assess and/or
address SDoH). Inclusion and exclusion criteria for (a) large, population-based studies, (b) smaller
studies of actionable SDoH factors, and (c) policy pieces including grey literature are outlined in
Supplemental Tables 8-10, respectively. Included articles must describe digital health technology or
novel data used to assess and/or address SDoH, broadly defined by multiple leading agencies
(National Academy, Institute of Medicine; Centers for Disease Control and Prevention; Office of
Disease Prevention and Health Promotion; Robert Wood Johnson Foundation; World Health
Organization; and Kaiser Family Foundation). Example inclusion criteria are health disparity,
tobacco use, educational status, unemployment, and housing instability. Example exclusion
criteria are in vivo and in vitro studies, non-systematic reviews, and global perspective.

Data were extracted into Excel tables from each of the studies meeting the inclusion/exclusion
criteria. Studies that met multiple criteria of interest (i.e., data, technology, and/or policy) were
categorized and counted more than once. Data were then checked by a second independent
reviewer. Supplemental Tables 11-13 provide data extraction organized into policy, digital health
technology, and data areas, respectively.

Results
Search Results and Identified Study Characteristics

Literature searches identified 2,714 potentially relevant articles for title abstract screening; 132
were identified for full-text screening, and 65 studies met the inclusion criteria. All search and
screening results are presented in Figure 1.

Figure 1. Disposition of articles and screening flow diagram

This flow diagram depicts the process and flow of information (including number of records of identified,
included and excluded study numbers, and reasons for exclusion) through the phases of the state-of-the-art
literature review.

Supplementary tables 11-13 present the characteristics of the included studies. Most studies were designed
retrospectively in US community settings, and all were full-texts. Of the 65 included articles, 13 referenced
SDoH in public health policies, 47 presented novel sources and/or novel uses of SDoH data, and 36
described technologies.

Overall, the 13 articles regarding policy focused on access, both improved access to smart mobile
devices or broadband internet (n=4), and the measurement, collection, and dissemination of SDOH
data (n=9). Of the 36 articles describing technology, most (n=23) pertained to utilization of
geocoding to translate patient addresses into spatial SDoH data, but AI (n=9) was also commonly
leveraged. Digital health technologies identified in three or fewer articles included social media,
other types of software (e.g., modeling or simulation software, transition of care platforms),
internet, mobile health (mHealth) sensors and applications (apps), video, and telehealth. Of the 47
articles pertaining to data, most (n=32) combined multiple types of data sources (e.g., electronic
4

health records [EHRs] and census data). Other data sources included EHRs (n=8), census (n=3),
state (n=2), federal (n=2), and internet (n=2). Baseline SDoH factor assessments were categorized
as: identity, behavioral, economic, neighborhood, physical environment, education, food, housing,
social relationships, transportation, health access and quality, employment, community,
governmental, and psychosocial. Identity (n=172), behavioral (n=98), and economic (n=53) were
the most commonly examined SDoH factors.

Improve Access with Policy

Expand consumer access to digital health technologies

Newer digital health technologies, including telemedicine platforms, mHealth apps, wearable
devices, patient portals, EHRs and health information exchanges, and other internet-based
technologies and services have the potential to disrupt and improve public health practice. Across
intervention types, governmental policy can incentivize behavior in healthcare and public health
practice. Therefore, policy-related publications addressing these technologies and SDoH were
examined. Findings showed that communities with insufficient resources and individuals with
limited health literacy face barriers to adoption [10].

Three articles focused on the need to improve access to digital health technologies to reduce health
disparities. In these articles, access to technology was limited to smart mobile devices or
broadband internet. Ray et al. (2017) showed disparities in the use of technology for accessing
health information by race/ethnicity and income. The authors recommended policies to improve
access to technology in these communities [11]. As vulnerable populations gain access to smart
phones, grant makers acknowledge that when combined with sound policy strategies, scalable
digital technologies supported by communities have the potential to positively impact health
disparities that vary by geography [12]. As demonstrated by recent increases in technology usage
by racial/ethnic minorities, the digital divide may be narrowing by race/ethnicity, but not by health
literacy. Chakkalakal et al. (2014) observed that individuals with limited health literacy were less
likely to own and/or utilize these technologies when compared to those with adequate health
literacy [13].

Improve standardization and interoperability of data

Recognizing that challenges with effective measurement and collection of SDoH data are barriers
to reducing health disparities, numerous public policy guidelines have encouraged the
incorporation of SDoH data in health-monitoring systems [14-16]. Four articles described and
recommended practices, and in some instances standardization and prioritization, in the
measurement of SDoH factors for actionable interventions [17-20]. The Public Health 3.0 initiative
prioritized education, safe environments, housing, transportation, economic development, and
access to healthy foods in community-level interventions utilizing cross-sector partnerships with
stakeholders [17]. Super Church (2015) described how one program, the Healthy Neighborhoods
Equity Fund, planned to use data to identify communities suffering disproportionately from health
disparities and would benefit most from a community intervention, including improvement in
“housing conditions, public safety, employment, transportation, walkability, and access to green
space and healthy food” [18]. SDoH factors included in the data assessment were community
support and growth potential, transportation access and use, walkability, housing affordability and
5

choice, safety, economic opportunity, recreational areas, food access, indoor air quality, and
building and site performance [18]. Cahill et al. (2016) provided recommendations for SDoH
factors that should be incorporated into an EHR as a part of meaningful use guidelines. The authors
argue that including sexual orientation and gender data (birth sex, preferred name and pronouns,
sexual orientation, and sexual practices/behaviors) in EHRs are vital to improving disparities in
sexually marginalized groups since this information will better inform providers and improve
patient care [19]. Providers and EHR vendors should also be trained on how to collect, interpret,
and use this information to best improve care for patients [19]. Lastly, Penman-Aguilar et al.
(2016) provided recommended practices for the measurement of SDoH factors at national and sub-
national (i.e., state) levels including: a priori identification of characteristics of groups that are
associated with less power and privilege or lower social position that may demonstrate within-
group heterogeneity, and they be measured at multiple levels, i.e., both the individual and
community levels. These domains include race/ethnicity, sex, sexual orientation and gender
identity, age, level of education, income, wealth, occupation, country of birth, disability status, and
geographic location [20]. Additionally, the standardization of methodologies for the measurement
of SDoH is an unmet need. However, the methodologies are greatly influenced by how the SDoH
information will be disseminated to a particular audience, so analytical methods are varied, which
can prevent or limit aggregation of datasets [20].

Despite multiple national programs [21, 22] underscoring the importance of capturing SDoH data
in EHRs to guide clinical care, SDOH data collection is currently insufficient. Two policy articles
not only assessed policies and programs to improve its collection, but also specified the level of
granularity to be collected [17, 23]. Douglas et al. (2015) identified gaps in data collection
requirements in the Health Information Technology for Economic and Clinical Health (HITECH)
Act of 2009 that drove the national adoption of EHRs. The authors noted deficiencies for collecting
data on certain demographics will, at the least, not help resolve health disparities and, at worst,
exacerbate them. It was recommended that the Act should require the collection of “more granular
race and ethnicity, disability status, and sexual orientation and gender identity” data in EHRs [23].
Demographic data obtained from studies supported by federally funded agencies (i.e., National
Academy of Medicine, Centers for Disease Control and Prevention, Department of Health and
Human Services [DHHS], etc.) are not comparable due to lack of alignment and program mandates
for its expanded collection [23]. Furthermore, inconsistent demographic data collection standards
between public health survey data and EHRs limit research interpretation and widen the health
disparities gap. In addition to demographic data being more granular, geographic granularity has
also been emphasized at the community level. DeSalvo et al. (2017) commented on Public Health
3.0, an initiative by the US DHHS to broaden the scope of public health to directly include
communities to address SDoH factors [17]. In efforts to achieve Public Health 3.0, data should be
made available to communities, which would enable real-time and geographically granular (i.e.,
county-level) data to be shared, connected, and interpreted to translate evidence into action [17].

To impact health outcomes, social determinants must be measured, and the data need to be
collected and widely disseminated. Four articles discussed the development, importance, and
concerns around sharing SDoH data [24-27]. Krumholz et al. (2016) provided recommendations
for data sharing, including 1) foster a culture of data sharing, 2) develop operational functionality
for data sharing, and 3) improve data sharing capacity [24]. Perlin et al. (2016) also provided
recommendations with a focus on the operationality of systems: interoperability between EHR
systems, improved cyber security, and a data strategy that supports a learning health system.
6

Finally, Smith et al. (2016) described the development and implementation of a data warehouse
and EHR system for Federally Qualified Health Centers in Maryland. Important aspects of the
system’s development included engaging partners, defining quality measures and processes for
validating data, and determining effective use of the data for clinical quality improvement. The
two biggest challenges in implementation were cost and communication of data and outcomes
within an organization and between organizations using population health software platforms [26].
However, privacy and security concerns related to the inclusion of SDoH data in EHRs remain
credible threats to their collection and subsequent sharing. At the individual level, many
measurements of the SDoH may be highly personal and sensitive. As such, compliance to security
and privacy laws, and implementation of good practices to provide stewardship of these data is
essential to earn patient trust and their willing disclosure of sensitive information [27].

Data Aggregation

Enrich SDoH insights by using multiple data sources

Innovative methods have been leveraged to mine existing data for new insights related to SDoH.
Many (74%) of the articles addressing data on SDoH combined multiple sources, both structured
(e.g., machine-readable data) and unstructured (e.g., text). EHRs and US census data were two of
the most commonly used sources to glean insights, but other sources included federal, state, and
local clinical data (e.g., nationally conducted health surveys, registry data). The use of non-clinical
data from public records (e.g., housing, crime, welfare) and novel third-party sources such as
internet content from social media (e.g., Twitter, Yelp) were also identified. Notably, when EHR
data is combined with other data sources to examine health outcomes, the number of SDoH factors
collected are enriched. Compared with EHR data alone, adding disparate data sources captures
additional SDoH factors (i.e., neighborhood, food, and education) and actionable insights which
provide opportunities for intervention at the community level.

Analytics and AI-based methods to aggregate data

The expanded scope of a population health approach, which incorporates non-clinical perspectives,
leads to an ecosystem composed of multiple, diverse data sources that need to be integrated to
obtain actionable insights at the individual and community levels. Geocoding, a geospatial analytic
technique, is one way to link these datasets by matching locations.

Geocoding (n=23) was the most frequent technology identified to assess and address SDoH.
Geocoding was broadly applied to link individual (most commonly, EHR) and community datasets
(e.g., US Census, state, or local data) to provide a meaningful, contextual, and geographic analysis
of SDoH, and was used primarily to capture identity, economic, neighborhood, and behavioral
factors across a variety of health outcomes. For example, Masho et al. (2017) used ArcGIS
software to perform geocoding to link three datasets: 10-year birth registry data, 2010 US Census
data, and crime statistics from a local police department [28]. The linked data enabled the inclusion
of more actionable SDoH, including neighborhood factors like safety which are not typically
captured within health data. The analytical assessments identified the association of social factors
with health outcomes; youth violence was associated with preterm birth despite controlling for
other variables at the individual and community levels [28]. Geocoding can be used to develop

targeted contextual and geographic interventions; in this instance, to reduce community violence
and preterm births in vulnerable populations.

The use of geocoding, which typically involves specification of latitude and longitude by
application programming interfaces (APIs) from mapping databases, has more benefits than
traditional linking via county or zip code. This level of geocoding provided more granularity and
facilitated the collection of more neighborhood and behavioral-related SDoH factors. Zip code
linking primarily provided information regarding community level measurements, such as income
and percent race/ethnicity [29, 30]. Other mechanisms of linking data included using probabilistic
software, “Link Plus,” [31] or a custom probabilistic algorithm to match different datasets [32].
However, these types of linking required the removal of protected health information before the
data could be disclosed to investigators, which is a barrier to their use.

Compared to standalone assessments, technology used to link datasets collects previously

unattainable SDoH factors. Combined data sets with geocoded EHRs can identify new SDoH
insights; for example, Perzynski et al. (2017) assessed whether SDoH affect healthcare utilization
via patient portals from outpatient clinics in an urban public health care system. EHR data was
geocoded to provide granularity at the census-tract (i.e., subdivision of county) levels and
combined with FCC 2013 Form 477 data (e.g., broadband internet usage) and American
Community Survey (ACS) data (e.g., neighborhood income and education level) [33]. These data
sources cumulatively revealed access to technology was significantly associated with patient portal
usage; the elderly, uninsured, and minority patients were less likely to use the portal. This approach
was insightful because it used both novel data sources and used data in new ways to identify the
association of an SDoH factor with healthcare utilization.

While advanced analytical tools in healthcare have been primarily used to link existing data
streams, some researchers have applied these tools to create novel datasets from non-traditional,
non-clinical sources. For example, Nguyen et al. (2017) leveraged geographically tagged
(geotagged, i.e., with geocoded data embedded in the media) social media data from Twitter and
Yelp to create a national food environment database [34]. The authors applied analytical tools
including AI techniques to discover patterns and emerging health-related issues in aggregated
datasets with geographically identified metadata. To assess sentiment regarding food consumption,
Machine Learning for LanguagE (MALLET) was used to analyze geotagged Twitter content (text
and images) from its API. Using data from the US Department of Agriculture national nutrient
database, algorithms were applied to calculate caloric density of popular food and alcohol tweet
content and to create a detailed view of the food environment using Yelp’s API. The social media
derived data were then linked to data from the ACS, Behavioral Risk Factor Surveillance System,
and National Vital Statistics Report to assess state-level health outcome data that included chronic
health conditions, all-cause mortality, and homicide rate, respectively. Data were then assessed to
determine whether state-level food environment variables obtained from social media were
associated with health outcomes. The data were further analyzed with additional granularity to
assess the relationship between county-level social media indicators and county health outcomes.
High caloric density food tweets and more burger Yelp listings were related to higher all-cause
mortality, diabetes, obesity, high cholesterol, and fair/poor self-rated health. More alcohol tweets
and Yelp bars and pub listings were related to higher state-level binge drinking, but, curiously,
lower mortality and lower percent reporting fair/poor self-rated health. The primary goal of
Nguyen et. al (2017) was to use social media data to assess attitudes, norms, and behavioral control
8

activities of a community; however, the study produced a novel, web-based national database that
captured social-environmental features at the county level to examine potential impacts on health
[34]. Social media and/or AI technologies were paired with geographic information in five of the
included studies assessing SDoH.

Analytics and AI-Based Methods to Identify and/or Assess SDoH

The application of AI, such as machine learning (ML) or natural language processing (NLP), can
augment the retrieval of SDoH hidden in unstructured data (e.g., text found in clinical notes or
social services documents). Nine articles used AI methods (n=7, ML; n=2, NLP) to facilitate the
extraction of SDoH terms from EHR data, provide care management insights, and/or provide
connectivity of disparate datasets using API as earlier described [34]. Oreskovic et al. (2017) used
keyword searching by NLP in an analytics platform to identify SDoH factors in EHRs related to
increased psychosocial risk, whereby patients may be eligible for enrollment in a care coordination
program [35]. In this instance, the authors determined that psychosocial risk factors are associated
with higher healthcare utilization and costs, and worsening clinical outcomes among Medicaid
patients. This modeling, used in conjunction with the care coordination program, allowed
providers and healthcare systems to assess and manage their risk pool after quantifying and
triaging psychosocial risk. Similarly, Jamei et al. (2017) built a neural network model to analyze
SDoH data from EHRs of a large health system to identify high-risk patients and predict all-cause
risk of 30-day hospital readmission [36]. The limited SDoH derived data (alcohol, drug, and
tobacco use) from the EHRs was supplemented with geocoded 2010 census data to the block-level
and matched patients’ addresses for linking purposes. The authors noted that the predictive power
of the model needed to be tested in data sources that contain more granular and structured SDoH,
such as that collected using SDoH screening tools, and suggested that NLP [37] could extract
additional SDoH measurements from case notes of individual patients. However, Navathe et al.
(2018) demonstrated that seven common SDoH factors (tobacco use, alcohol use, drug abuse,
depression, housing instability, fall risk, and poor social support) were more readily identified in
the unstructured physician notes of an EHR using NLP extraction when compared to screening
administrative sources, such as claims and structured EHR data [38]. Automated methods for
analyzing physician notes enabled better identification of social needs of patients at risk for
readmission. Programs, particularly those with finite resources, greatly benefit from this novel
approach to assessing SDoH data.

Discussion
This review of the literature acknowledges that access to data along with innovative datasets and
digital technologies improve population health strategies for SDoH assessment (Figure 2). Most
studies focused on identity, economic, and sociobehavioral factors in relation to health outcomes.
Demographic factors (e.g., identity and economic) are more easily and frequently collected than
more actionable factors. However, interventions for behavioral-related SDoH factors are more
feasible and have demonstrated examples of high ROI (ROI range, $7.60 to $16.70 returned for
every US dollar spent) to promote healthy eating and weight loss [39, 40]. Policy recommendations
[8, 17] to prioritize other actionable SDoH factors such as education, food, and housing in targeted
interventions show reduced costs [41-43].

Figure 2. Using multiple datasets with digital health technologies adds the most value

Abbreviations: ROI, return on investment; SDoH, social determinants of health.

Combining data sets may be challenging, but the result can beneficially address SDoH. Combining
multiple data sources allows for the study of novel SDoH by linking data less commonly used in
healthcare research, such as access to healthy foods or neighborhood safety, with health outcome
data. However, linking datasets owned by separate entities can be difficult because of patient
privacy concerns; to be compliant with privacy laws, personal health information has to be
removed from datasets before they are shared with external researchers, so individual patient data
cannot be matched across datasets. Several studies utilizing technology to facilitate data linking
through geocoding were identified but may be limited by constructive identification.

Technology can facilitate the integration of multiple data sources to assess SDoH for new insights.
For example, technologies with advanced analytics methods, including the use of AI-based
algorithms, has the ability to provide personalized care to patients and support comprehensive,
effective, and thoughtful care management. The development of predictive models can assist
decision makers in cost-saving analyses to more effectively schedule and optimize hospital
resources by identifying high-risk patients and correctly determining where resources will provide
the most benefit (e.g., providing timely intervention to reduce hospital readmission in high-risk
patients). The use of advanced analytics and AI-based services, including cloud-based AI analytics
microservices, to address SDoH is paramount to generate data insights to inform decision-making.

Despite its value, technology can also be a barrier. Digital health technology access is not a
commonly measured SDoH factor, and lack of access can both result in biased data collection (e.g.,
only collecting data from patients with technology access) and contribute to further disparities
because of the “digital divide,” whereby lack of technology literacy and broadband access or
mobile phones worsen economic and social inequalities. Notably, policy considerations focused
on the need to improve access to digital health technology to reduce health disparities.
10

Furthermore, incentive-based policies can help create positive habits and behavior and break
negative habits in the short-term; however, sustained behavior change continues to be a challenge
for many.

There are some limitations to this review. Despite exhaustive search methods, a priori inclusion
criteria, and dual screening of full-texts under review, the included studies were ranked by greater
generalizability, longer follow-up, larger sample sizes, and articles published between 2013-2018.

Future Directions
As healthcare transitions to value-based care delivery, harnessing data sources and leveraging
technology to collect SDoH will be essential. The ability to leverage big data for population health
management has the potential to improve health outcomes, bridge gaps in care, and reduce costs.
The integration of data from disparate sources to understand the composition of the population and
stratify individuals according to risk scores will be transformative; the identification of underlying
factors that influence patient and community health allows for more practical and meaningful care.
The collection of SDoH data, particularly those with high potential ROI, is essential for a more
holistic view of the patient to be reflected in patient records and the consolidation of this
information across care teams. Clinical enablement tools to capture SDoH factors and to obtain
missing SDoH data need to be improved and broadly integrated. Digital health technology and
data have the potential to augment and scale labor-intensive and manual processes to identify
social needs for the patient, whereby healthcare providers can connect them to the appropriate
resources to overcome those barriers to health. With the evolution of technology and value-based
care for patient management, it will require the collaboration between clinical and social care
teams to improve health disparities related to SDoH with the goal of improving health equity.

Conclusions
If multiple datasets and advanced analytical technologies can be effectively integrated, and
consumers have access to and literacy of technology, more SDoH insights can be identified and
targeted to improve public health. This study identified examples of AI-based use cases in public
health informatics, and this literature is very limited.

Acknowledgements
We would like to thank Bill Marder and Ron Ozminkowski for project guidance; Rachel Faller for
screening and abstraction; Brett South, Megan Sands-Lincoln, Mason Russell, and Laura Morgan
for critical reading; and Dave Liederbach and Kyu Rhee for project support.

Financial Disclosure
This research study was supported by IBM® Watson Health®.

Competing Interests
The authors are or were employed by IBM® Corporation and have no conflicts germane to this
study.
11

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Supplementary Material
Supplemental Table 1. Medline Search (via PubMed)
Search results
Search no. Facet Search terms
(May 16, 2018)
1 “Social Determinants of Health” [MeSH] OR “social 28,882
determinants of health”[tiab] OR “health status
disparities”[MeSH] OR “health status
disparities”[tiab] OR “health equity”[MeSH] OR
“health equity”[tiab] OR “social determinant” OR
“social determinants” OR “health disparity” OR
“health disparities”
Identify studies
2 “tobacco use”[tiab] OR “alcohol and illicit drug 1,497,418
on social
use”[tiab] OR “physical activity”[tiab] OR “diet”[tiab]
determinants of
OR “obesity”[tiab] OR “health literacy”[MeSH] OR
health.
“health literacy”[tiab] OR “early intervention
education”[MeSH] OR “educational status”[MeSH]
OR “educational status”[tiab] OR “high school
graduation”[tiab] OR “early childhood
education”[tiab] OR “language proficiency”[tiab] OR
“employment”[tiab] OR “unemployment”[tiab] OR
“socioeconomic factors”[MeSH] OR “socioeconomic
factors”[tiab] OR “socioeconomic disparities”[tiab]
19

OR “income”[tiab] OR “social support”[tiab] OR

“built environment”[tiab] OR “food insecurity”[tiab]
OR “food security”[tiab] OR “access to healthy
food”[tiab] OR incarcerat*[tiab] OR “crime”[tiab] OR
“violence”[tiab] OR “civil rights”[MeSH] OR “civil
rights”[tiab] OR “civic participation”[tiab] OR
“gender”[tiab] OR “discrimination”[tiab] OR
“walkability”[tiab] OR “housing instability”[tiab] OR
“quality of housing”[tiab] OR “environmental
health”[MeSH] OR “environmental health”[tiab] OR
“environmental conditions”[tiab] OR
“transportation”[tiab] OR “urbanization”[tiab] OR “air
quality”[tiab]
3 #1 AND #2 15,755
4 “social determinants of health”[tiab] OR "social 3,913
determinants of health"[MeSH]
5 #3 OR #4 17,386
6 “analytic*”[tiab] OR “database*”[tiab] OR “data 861,933
interpretation, statistical”[MeSH] OR “data
analysis”[tiab] OR “data mining”[tiab] OR “electronic
Identify studies
health records” [MeSH] OR “electronic health
that use data
record”[tiab] OR “personal health record”[tiab] OR
analytics.
“data set*”[tiab] OR “survey*”[tiab] OR “standards-
based assessment*” OR “claims data”[tiab] OR
“electronic medical record”[tiab]
7 Identify studies #5 AND #6 4058
that use data
analytics and
report on social
determinants of
health.
8 #7 NOT (“Australia”[Mesh] OR “Canada”[Mesh] OR 2,409
“Mexico”[Mesh] OR “Europe”[Mesh] OR
Exclude non-
“China”[Mesh] OR “Russia”[Mesh] OR
US studies.
“Africa”[Mesh] OR “Asia”[Mesh] OR “South
America”[Mesh] OR “iran”[tiab] OR “Africa”[tiab])
9 Exclude in vivo #8 NOT (“in vivo” OR “in vitro”) 2,408
and in vitro
studies.
10 Review[pt] NOT (Cochrane OR systematic or meta- 2,129,768
analy*)

11 Exclude non- #9 NOT #10 2,374

systematic
reviews.
12 Exclude other #11 NOT (“case reports”[pt] OR “case report” OR 2,367
inappropriate “case series” OR “editorial”[pt] OR “letter”[pt])
study designs.
13 Exclude studies #12 NOT “global health”[tiab] 2340
with a global
perspective.
14 Filter for #13 AND [humans] 1859
human studies.
15 Filter for #14 AND [abstract] 1848
publications
with abstracts.
16 Filter by #15 AND 2013-2018 [dp] 1032
publication
date (last five
years).
17 Filter for #16 AND [English] 1029
publications
written in
English.
Supplemental Table 2. Cochrane Library Search
Search
results
Search no. Facet Search terms
(May 18,
2018)
1 Social determinants of health[Mesh] OR “social 1057
determinants of health” OR Health status
disparities[Mesh] OR “health status disparities” OR
Health equity[Mesh] OR “health equity” OR “Social
determinant*” OR “health disparity” OR “health
Identify studies disparities”
on social
2 determinants of “tobacco use” OR “alcohol and illicit drug use” OR 123,755
health. “physical activity” OR “diet” OR “obesity” OR “health
literacy”[MeSH] OR “health literacy” OR “early
intervention education”[MeSH] OR “educational
status”[MeSH] OR “educational status” OR “high
school graduation” OR “early childhood education”
OR “language proficiency” OR “employment” OR
21

“unemployment” OR “socioeconomic factors”[MeSH]

OR “socioeconomic factors” OR “socioeconomic
disparities” OR “income” OR “social support” OR
“built environment” OR “food insecurity” OR “food
security” OR “access to healthy food” OR incarcerat*
OR “crime” OR “violence” OR “civil rights” OR “civil
rights” OR “civic participation” OR “gender” OR
“discrimination” OR “walkability” OR “housing
instability” OR “quality of housing” OR
“environmental health”[MeSH] OR “environmental
health” OR “environmental conditions” OR
“transportation” OR “urbanization” OR “air quality”
3 #1 AND #2 646
4 Social determinants of health[Mesh] OR “social 150
determinants of health”
5 #3 OR #4 698
6 “analytic*” OR “database*” OR “data interpretation, 124,309
statistical”[MeSH] OR “data analysis” OR “data
Identify studies mining” OR “electronic health records” [MeSH] OR
that use data “electronic health record” OR “personal health record”
analytics. OR “data set*” OR “survey*” OR “standards-based
assessment*” OR “claims data” OR “electronic
medical record”
7 Identify studies #5 AND #6 226
that use data
analytics and
report on social
determinants of
health.
8 Exclude in vivo #7 NOT (“in vivo” OR “in vitro”) 219
and in vitro
studies.
9 Filter by #8 AND (2013-2018) 126
publication date
(last five years).
10* Filter to include #9 AND trials 71
only trials.
11* Filter to include #9 AND (tech assessments) 4
only technology
assessments.

12* Filter to include #9 AND (reviews) 51

systematic
reviews.
*Note: Rows 10, 11, and 12 all appear in the final results of the search; a total of 126 records
were identified from the Cochrane Library search.
Supplemental Table 3. Embase Search
Search results
Search no. Facet Search terms
(May 18, 2018)
1 ‘social determinants of health’/exp OR ‘social 29,137
determinants of health’:ab,ti OR ‘health disparity’/exp
OR ‘health disparit*’:ab,ti OR ‘health equity’/exp OR
‘health equity’:ab,ti OR ‘social determinant*’
2 ‘tobacco use’/exp OR ‘tobacco use’:ab,ti OR ‘alcohol 2,654,021
and illicit drug use’:ab,ti OR ‘physical activity’/exp
OR ‘physical activity’:ab,ti OR ‘diet’/exp OR
‘diet’:ab,ti OR ‘obesity’/exp OR ‘obesity’:ab,ti OR
‘health literacy’/exp OR ‘health literacy’:ab,ti OR
‘early childhood intervention’/exp OR ‘educational
status’/exp OR ‘educational status’:ab,ti OR ‘high
school graduate’:ab,ti OR ‘early childhood
education’:ab,ti OR ‘language ability’/exp OR
‘language proficiency’:ab,ti OR ‘employment’:ab,ti
OR ‘unemployment’:ab,ti OR ‘socioeconomics’/exp
Identify studies OR ‘socioeconomic factors’:ab,ti OR ‘socioeconomic
on social disparities’:ab,ti OR ‘income’:ab,ti OR ‘social
determinants of support’:ab,ti OR ‘built environment’:ab,ti OR ‘food
health. insecurity’/exp OR ‘food security’:ab,ti OR ‘access to
healthy food’:ab,ti OR ‘incarcerat*’:ab,ti OR
‘crime’:ab,ti OR ‘violence’:ab,ti OR ‘civil rights’/exp
OR ‘civil rights’:ab,ti OR ‘civic participation’:ab,ti
OR ‘gender’:ab,ti OR ‘discrimination’:ab,ti OR
‘walkability’:ab,ti OR ‘housing instability’:ab,ti OR
‘quality of housing’/ab,ti OR ‘environmental
health’/exp OR ‘environmental health’:ab,ti OR
‘environmental conditions’:ab,ti OR
‘transportation’:ab,ti OR ‘urbanization’:ab,ti OR ‘air
quality’:ab,ti
3 #1 AND #2 15,802
4 ‘social determinants of health’/exp OR ‘social 5,326
determinants of health’:ab,ti
5 #3 OR #4 18,046

6 ‘analytic*’:ab,ti OR ‘database’:ab,ti OR ‘statistical 3,029,553

analysis’/exp OR ‘data analysis’:ab,ti OR ‘data
mining’:ab,ti OR ‘electronic health record’/exp OR
Identify studies
‘electronic health record’:ab,ti OR ‘personal health
that use data
record’:ab,ti OR ‘data set*’:ab,ti OR ‘survey’:ab,ti OR
analytics.
‘standards-based assessment*’:ab,ti OR ‘claims
data’:ab,ti OR ‘electronic medical record’/exp OR
‘electronic medical record’:ab,ti
7 Identify studies #5 AND #6 5,946
that use data
analytics and
report on social
determinants of
health.
8 #7 NOT (‘Australia and New Zealand’/exp OR 3,574
Exclude non- ‘Canada’/exp OR ‘Mexico’/exp OR ‘Europe’/exp OR
US studies. ‘China’/exp OR ‘Russia’/exp OR ‘Africa’/exp OR
‘Asia’/exp OR ‘South America’/exp OR ‘Iran’/exp)
9 Exclude in vivo #8 NOT (‘in vivo’ OR ‘in vitro’) 3,567
and in vitro
studies.
10 Exclude non- [review]/lim NOT (Cochrane OR systematic OR 2,275,010
systematic ‘meta-analy*’)
11 reviews. #9 NOT #10 3,471
12 Exclude other ‘case report’/exp OR ‘case report*’ OR ‘case 2,460,562
inappropriate study’/exp OR ‘case series’
13 study designs. #11 NOT #12 3,457
14 Exclude studies #13 NOT (‘global health’:ab,ti) 3,422
with a global
perspective.
15 Filter for #14 AND [humans]/lim 3,295
human studies.
16 Filter for #15 AND [abstracts]/lim 3,235
publications
with abstracts.
17 Filter by #16 AND [2013-20180/py 2,216
publication
date (last 5
years).

18 Filter for #17 AND [English]/lim 2,195

publications
written in
English.
Supplemental Table 4. Medline Search (via PubMed)
Search
results
Search no. Facet Search terms
(May 23,
2018)
1 “Social Determinants of Health” [MeSH] OR “social 38,924
determinants of health”[tiab] OR “health status
Identify articles disparities”[MeSH] OR “health status disparities”[tiab]
on social OR “health equity”[MeSH] OR “health equity”[tiab]
determinants of OR “social determinant” OR “social determinants” OR
health. “health disparity” OR “health disparities” OR
healthcare disparities[MeSH] OR minority
health[MeSH]
2 Identify articles Health Policy[MeSH] OR health policy[tw] OR 109,876
on health policy. healthcare policy[tw]
3 Electronic Health Records[Mesh] OR “electronic 171,779
health record*”[tiab] OR “electronic registry”[tiab] OR
“electronic registries”[tiab] OR "Health Information
Exchange"[Mesh] OR “health information
exchange*”[tiab] OR "Decision Support Systems,
Clinical"[Mesh] OR “clinical decision support
system*”[tiab] OR "Social Networking"[Mesh] OR
Identify studies
“social networking”[tiab] OR "Health Records,
that use digital
Personal"[Mesh] OR “personal health record*”[tiab]
health
OR “electronic health information”[tiab] OR
technology.
“electronic health communication*”[tiab] OR “patient
monitor*”[tiab] OR "Patient Portals"[Mesh] OR
“patient portal*”[tiab] OR "Telemedicine"[Mesh]
OR ”telemedicine”[tiab] OR telehealth[tiab] OR
electronic medical record[tiab] OR data analytics[tw]
OR data mining[tiab] OR data interpretation,
statistical[MeSH] OR data analysis[tiab]
4 Identify policy #1 AND #2 AND #3 39
studies that use
digital health
technology and
report on social

determinants of
health.
5 #4 NOT (Australia[Mesh] OR Canada[Mesh] OR 24
Mexico[Mesh] OR Europe[Mesh] OR China[Mesh]
Exclude non-US OR Russia[Mesh] OR Africa[Mesh] OR Asia[Mesh]
studies. OR South America[Mesh] OR Iran[tiab] OR
Canada[tiab] OR New Zealand[tiab] OR United
Kingdom[tiab] OR Great Britain[tiab])
6 Exclude studies #5 NOT (global health[MeSH] OR global health[tiab] 23
with a global
perspective.
7 Filter for #6 AND [abstract] 22
publications
with abstracts.
8 Filter by #7 AND 2013-2018 [dp] 16
publication date
(last 5 years).
9 Filter for #8 AND [English] 16
publications
written in
English.

Supplemental Table 5. Medline Search (via PubMed)

Search results
Search no. Facet Search terms
(May 31, 2018)
1 Search ("Social Determinants of Health" [MeSH] OR 29,065
Identify articles "social determinants of health"[tiab] OR "health status
on social disparities"[MeSH] OR "health status disparities"[tiab]
determinants of OR "health equity"[MeSH] OR "health equity"[tiab]
health. OR "social determinant" OR "social determinants" OR
"health disparity" OR "health disparities")

2 Search ("tobacco use"[tiab] OR "alcohol and illicit 1,501,371

drug use"[tiab] OR "physical activity"[tiab] OR
"diet"[tiab] OR "obesity"[tiab] OR "health
literacy"[MeSH] OR "health literacy"[tiab] OR "early
intervention education"[MeSH] OR "educational
status"[MeSH] OR "educational status"[tiab] OR
"high school graduation"[tiab] OR "early childhood
education"[tiab] OR "language proficiency"[tiab] OR
"employment"[tiab] OR "unemployment"[tiab] OR
"socioeconomic factors"[MeSH] OR "socioeconomic
factors"[tiab] OR "socioeconomic disparities"[tiab]
OR "income"[tiab] OR "social support"[tiab] OR
"built environment"[tiab] OR "food insecurity"[tiab]
OR "food security"[tiab] OR "access to healthy
food"[tiab] OR incarcerat*[tiab] OR "crime"[tiab] OR
"violence"[tiab] OR "civil rights"[MeSH] OR "civil
rights"[tiab] OR "civic participation"[tiab] OR
"gender"[tiab] OR "discrimination"[tiab] OR
"walkability"[tiab] OR "housing instability"[tiab] OR
"quality of housing"[tiab] OR "environmental
health"[MeSH] OR "environmental health"[tiab] OR
"environmental conditions"[tiab] OR
"transportation"[tiab] OR "urbanization"[tiab] OR "air
quality"[tiab])
3 Search (#1 AND #2) 15,845
4 Search ("social determinants of health"[tiab] OR 3,947
"social determinants of health"[MeSH])
5 Search (#3 OR #4) 17,493

6 Search ("Artificial Intelligence"[Mesh] OR "artificial 131,429

intelligence"[tiab] OR "machine intelligence"[tiab]
OR "computational intelligence"[tiab] OR "Machine
Learning"[Mesh] OR "machine learning"[tiab] OR
"machine-learning"[tiab] OR "Computer
Security"[Mesh] OR "data security"[tiab] OR
"cybersecurity"[tiab] OR "cyber security"[tiab] OR
"data protect*"[tiab] OR "data encrypt*"[tiab] OR
"Cloud Computing"[Mesh] OR "cloud
Identify studies
computing"[tiab] OR "cloud process*"[tiab] OR
that use digital
"cognitive comput*"[tiab] OR "Patient Portals"[Mesh]
health
OR "patient web portal*"[tiab] OR "patient web-
technology.
portal*"[tiab] OR "patient portal*"[tiab] OR "web
portal*"[tiab] OR "mobile technolog*"[tiab] OR
"Telemedicine"[Mesh] OR "telemedicine"[tiab] OR
"telehealth*"[tiab] OR "mobile health"[tiab] OR
"mHealth"[tiab] OR "eHealth"[tiab] OR "m-
Health"[tiab] OR "mobile-health"[tiab] OR
"telecommunication*"[tiab] OR "Decision Support
Systems, Clinical"[Mesh] OR "clinical decision
support"[tiab] OR "decision support system"[tiab])
7 Identify studies Search (#5 AND #6) 112
that use digital
health
technology and
report on social
determinants of
health.
8 Search (#7 NOT ("Australia"[Mesh] OR 102
"Canada"[Mesh] OR "Mexico"[Mesh] OR
Exclude non- "Europe"[Mesh] OR "China"[Mesh] OR
US studies. "Russia"[Mesh] OR "Africa"[Mesh] OR "Asia"[Mesh]
OR "South America"[Mesh] OR "iran"[tiab] OR
"Africa"[tiab]))
9 Exclude in vivo Search (#8 NOT ("in vivo" OR "in vitro")) 102
and in vitro
studies.
10 Exclude non- Search (Review[pt] NOT (Cochrane OR systematic or 2,133,577
systematic meta-analy*))
11 reviews. Search (#9 NOT #10) 93
12 Exclude other Search (#11 NOT ("case reports"[pt] OR "case report" 90
inappropriate OR "case series" OR "editorial"[pt] OR "letter"[pt]))
study designs.

13 Exclude studies Search (#12 NOT "global health"[tiab]) 89

with a global
perspective.
14 Filter for Search (#12 NOT "global health"[tiab]) Filters: 51
human studies. Humans
15 Filter for Search (#12 NOT "global health"[tiab]) Filters: 49
publications Abstract; Humans
with abstracts.
16 Filter by Search (#12 NOT "global health"[tiab]) Filters: 37
publication Abstract; Publication date from 2013/01/01; Humans
date (last 5
years).
17 Filter for Search (#12 NOT "global health"[tiab]) Filters: 37
publications Abstract; Publication date from 2013/01/01; Humans;
written in English
English.

Supplemental Table 6. Cochrane Library Search

Search Results
Search no. Facet Search Terms
(June 1, 2018)
1 Social determinants of health[Mesh] OR 920
“social determinants of health”:ti,ab,kw OR
Health status disparities[Mesh] OR “health
status disparities”:ti,ab,kw OR Health
equity[Mesh] OR “health equity”:ti,ab,kw OR
“Social determinant*”:ti,ab,kw OR “health
disparity”:ti,ab,kw OR “health
disparities”:ti,ab,kw
2 “tobacco use”:ti,ab,kw OR “alcohol and illicit 121,365
Identify articles on drug use”:ti,ab,kw OR “physical
social determinants of activity”:ti,ab,kw OR “diet”:ti,ab,kw OR
health. “obesity”:ti,ab,kw OR “health
literacy”[MeSH] OR “health literacy”:ti,ab,kw
OR
“early intervention (education)”[MeSH] OR
“educational status”[MeSH] OR “educational
status”:ti,ab,kw OR “high school
graduation”:ti,ab,kw OR “early childhood
education”:ti,ab,kw OR “language
proficiency”:ti,ab,kw OR
“employment”:ti,ab,kw OR
29

“unemployment”:ti,ab,kw OR
“socioeconomic factors”[MeSH] OR
“socioeconomic factors”:ti,ab,kw OR
“socioeconomic disparities”:ti,ab,kw OR
“income”:ti,ab,kw OR “social
support”:ti,ab,kw OR “built
environment”:ti,ab,kw OR “food
insecurity”:ti,ab,kw OR “food
security”:ti,ab,kw OR “access to healthy
food”:ti,ab,kw OR incarcerat*:ti,ab,kw OR
“crime”:ti,ab,kw OR “violence”:ti,ab,kw OR
“civil rights”:ti,ab,kw OR “civic
participation”:ti,ab,kw OR “gender”:ti,ab,kw
OR “discrimination”:ti,ab,kw OR
“walkability”:ti,ab,kw OR “housing
instability”:ti,ab,kw OR “quality of
housing”:ti,ab,kw OR “environmental
health”[MeSH] OR “environmental
health”:ti,ab,kw OR “environmental
conditions”:ti,ab,kw OR
“transportation”:ti,ab,kw OR
“urbanization”:ti,ab,kw OR “air
quality”:ti,ab,kw
3 #1 AND #2 533
4 Social determinants of health[Mesh] OR 83
“social determinants of health”:ti,ab,kw
5 #3 OR #4 551
6 “artificial intelligence”[MeSH] OR “artificial 7,930
intelligence”:ti,ab,kw OR “machine
intelligence”:ti,ab,kw OR “computational
intelligence”:ti,ab,kw OR “machine
learning”[MeSH] OR “machine
learning”:ti,ab,kw OR “machine-
learning”:ti,ab,kw OR “computer
Identify studies that use security”[MeSH] OR “data security”:ti,ab,kw
digital health OR “cybersecurity”:ti,ab,kw OR “cyber
technology. security”:ti,ab,kw OR “data protect*”:ti,ab,kw
OR “data encrypt*”:ti,ab,kw OR “cloud
computing”[MeSH] OR “cloud
computing”:ti,ab,kw OR “cloud
process*”:ti,ab,kw OR “cognitive
comput*”:ti,ab,kw OR “patient
portals”[MeSH] OR “patient web
portal*”:ti,ab,kw OR ”patient web-

portal*”:ti,ab,kw OR “patient
portal*”:ti,ab,kw OR “web portal*”:ti,ab,kw
OR “mobile technolog*”:ti,ab,kw OR
“telemedicine”[MeSH] OR
“telemedicine”:ti,ab,kw OR
“telehealth*”:ti,ab,kw OR “mobile
health”:ti,ab,kw OR “mHealth”:ti,ab,kw OR
“eHealth”:ti,ab,kw OR “m-Health”:ti,ab,kw
OR “mobile-health”:ti,ab,kw OR
“telecommunication*”:ti,ab,kw OR “Decision
support systems, clinical”[MeSH] OR
“clinical decision support”:ti,ab,kw OR
“decision support system”:ti,ab,kw
7 Identify studies that use #5 AND #6 17
digital health technology
and report on social
determinants of health.
8 Exclude in vivo and in #7 NOT (“in vivo” OR “in vitro”) 17
vitro studies.
9 Filter by publication #8 AND Publication Year from 2013 to 2018 15
date (last 5 years).

Supplemental Table 7. Embase Search

Search Results
Search no. Facet Search Terms
(June 4, 2018)
1 ‘social determinants of health’/exp OR ‘social 29,426
determinants of health’:ab,ti OR ‘health
disparity’/exp OR ‘health disparit*’:ab,ti OR
‘health equity’/exp OR ‘health equity’:ab,ti
OR ‘social determinant*’
2 ‘tobacco use’/exp OR ‘tobacco use’:ab,ti OR 2,741,489
‘alcohol and illicit drug use’:ab,ti OR
Identify articles on
‘physical activity’/exp OR ‘physical
social determinants of
activity’:ab,ti OR ‘diet’/exp OR ‘diet’:ab,ti
health.
OR ‘obesity’/exp OR ‘obesity’:ab,ti OR
‘health literacy’/exp OR ‘health literacy’:ab,ti
OR ‘early childhood intervention’/exp OR
‘educational status’/exp OR ‘educational
status’:ab,ti OR ‘high school graduate’:ab,ti
OR ‘early childhood education’:ab,ti OR
‘language ability’/exp OR ‘language
proficiency’:ab,ti OR ‘employment’:ab,ti OR
31

‘unemployment’:ab,ti OR
‘socioeconomics’/exp OR ‘socioeconomic
factors’:ab,ti OR ‘socioeconomic
disparities’:ab,ti OR ‘income’:ab,ti OR ‘social
support’:ab,ti OR ‘built environment’:ab,ti OR
‘food insecurity’/exp OR ‘food security’:ab,ti
OR ‘access to healthy food’:ab,ti OR
‘incarcerat*’:ab,ti OR ‘crime’:ab,ti OR
‘violence’:ab,ti OR ‘civil rights’/exp OR ‘civil
rights’:ab,ti OR ‘civic participation’:ab,ti OR
‘gender’:ab,ti OR ‘discrimination’:ab,ti OR
‘walkability’:ab,ti OR ‘housing
instability’:ab,ti OR ‘quality of housing’:ab,ti
OR ‘environmental health’/exp OR
‘environmental health’:ab,ti OR
‘environmental conditions’:ab,ti OR
‘transportation’:ab,ti OR ‘urbanization’:ab,ti
OR ‘air quality’:ab,ti
3 #1 AND #2 15,949
4 ‘social determinants of health’/exp OR ‘social 5,439
determinants of health’:ab,ti
5 #3 OR #4 18,251
6 ‘artificial intelligence’/exp OR ‘artificial 393,620
intelligence’:ab,ti OR ‘machine
intelligence’:ab,ti OR ‘computational
intelligence’:ab,ti OR ‘machine learning’/exp
OR ‘machine learning’:ab,ti OR ‘machine-
learning’:ab,ti OR ‘computer security’/exp OR
‘data security’:ab,ti OR ‘cybersecurity’:ab,ti
OR ‘cyber security’:ab,ti OR ‘data
protect*’:ab,ti OR ‘data encrypt*’:ab,ti OR
Identify studies that use ‘cloud computing’/exp OR ‘cloud
digital health computing’:ab,ti OR ‘cloud process*’:ab,ti
technology. OR ‘cognitive comput*’:ab,ti OR ‘medical
record’/exp OR ‘patient web portal*’:ab,ti OR
‘patient web-portal*’:ab,ti OR ‘patient
portal*’:ab,ti OR ‘web portal*’:ab,ti OR
‘mobile technolog*’:ab,ti OR
‘telemedicine’/exp OR ‘telemedicine’:ab,ti
OR ‘telehealth*’:ab,ti OR ‘mobile
health’:ab,ti OR ‘mHealth’:ab,ti OR
‘eHealth’:ab,ti OR ‘m-Health’:ab,ti OR
‘mobile-health’:ab,ti OR
‘telecommunication*’:ab,ti OR ‘clinical

decision support system’/exp OR ‘clinical

decision support’:ab,ti OR ‘decision support
system’:ab,ti
7 Identify studies that use #5 AND #6 398
digital health
technology and report
on social determinants
of health.
8 #7 NOT (‘Australia and New Zealand’/exp 330
OR ‘Canada’/exp OR ‘Mexico’/exp OR
Exclude non-US
‘Europe’/exp OR ‘China’/exp OR
studies.
‘Russia’/exp OR ‘Africa’/exp OR ‘Asia’/exp
OR ‘South America’/exp OR ‘Iran’/exp)
9 Exclude in vivo and in #8 NOT (‘in vivo’ OR ‘in vitro’) 330
vitro studies.
10 [review]/lim NOT (Cochrane OR systematic 2,270,891
Exclude non-systematic OR ‘meta-analy*’)
reviews.
11 #9 NOT #10 310
12 Exclude other ‘case report’/exp OR ‘case report*’ OR ‘case 2,495,228
inappropriate study study’/exp OR ‘case series’
designs.
13 Exclude studies with a #11 NOT #12 306
14 global perspective. #13 NOT (‘global health’:ab,ti) 305
15 Filter for human #14 AND [humans]/lim 295
studies.
16 Filter for publications #15 AND [abstracts]/lim 263
with abstracts.
17 Filter by publication #16 AND [2013-2018]/py 212
date (last 5 years).
18 Filter for publications #17 AND [English]/lim 211
written in English.

Supplemental Table 8. Inclusion/Exclusion Criteria for Large, Population-Based Studies

Inclusion Criteria Exclusion Criteria
The publication is in English. The publication is in a language other than English.
The publication contains an abstract. The publication does not contain an abstract.

The publication date is within the last five years The publication date is not within the last five years.
(2013-2018).
The publication describes a primary study The publication describes a study design other than
(prospective or retrospective; observational or primary study or systematic review (eg, case report,
experimental; comparative or non-comparative), case series, editorial, narrative review).
or systematic review with or without meta-
analyses (if systematic review is of only United
States studies).
The publication describes a study that takes The publication describes a study that takes place or
place in the United States or pertains to policy in pertains to policy in a country other than the United
the United States. States.
The publication focuses on a social, behavioral, The publication is not focused on a social, behavioral,
or environmental determinant of health factor (as or environmental determinant of health factor; the
predictors). publication is focused on access to care or clinical care
without addressing a social, behavioral, or
environmental determinant.
The publication reports an association of factors The publication does not report a health-related
related to health outcomes (allows for both outcome.
positive, null, and negative associations).
The publication reports a NEW data source The publication reports a previously identified data
(electronic health records (EHRs), claims data, source (Behavioral Risk Factor Surveillance System,
administrative data, geocoded data (GIS), National Health Interview Survey, American Census,
geographic data, personal health records) that American Community Survey, National Health and
may use tools (surveys, scales, assessments, Nutrition Examination Survey) or uses tools (surveys,
questionnaires, etc.) in a large population. scales, assessments, questionnaires, etc.) in a small
population.
The study reports rigorous data: the data set has The study does not report rigorous data: The data set has
a sample size of greater than 10,000 and a sample size less than 10,000 or does not provide
provides granularity (meaning the authors granularity.
provide details about the levels of data utilized).

Supplemental Table 9. Inclusion/Exclusion Criteria for the Smaller Studies of Actionable

SDoH Factors
Inclusion Criteria Exclusion Criteria
The publication is in English. The publication is in a language other than English.
The publication contains an abstract. The publication does not contain an abstract.
The publication date is within the last five years The publication date is not within the last five years.
(2013-2018).

The publication describes a primary study The publication describes a study design other than
(prospective or retrospective; observational or primary study or systematic review (eg, case report,
experimental; comparative or non-comparative), case series, editorial, narrative review).
or systematic review with or without meta-
analyses (if systematic review is of only United
States studies).
The publication describes a study that takes The publication describes a study that takes place or
place in the United States or pertains to policy in pertains to policy in a country other than the United
the United States. States.
The publication focuses on an actionable social, The publication is not focused on a social, behavioral,
behavioral, or environmental determinant of or environmental determinant of health factor; the
health factor (as predictors). publication is focused on access to care or clinical care
without addressing a social, behavioral, or
E.g., housing and stability, transportation, early
education, utility assistance, interpersonal environmental determinant.
safety, social support, and food insecurity.
The publication reports an association of The publication does not report a health-related
actionable factors related to health outcomes outcome.
(allows for both positive, null, and negative
associations).
The publication uses NOVEL data sources The publication does not use data sources or technology
and/or digital health technology (electronic or describes data already identified by
health records, artificial intelligence, machine- determinantsofhealth.org.
learning, advanced analytics, patient portals,
national surveys, insurance claims data,
advanced analytics, etc.).

Supplemental Table 10. Inclusion/Exclusion Criteria for Policy Pieces (including grey
literature)
Inclusion Criteria Exclusion Criteria
The publication is in English. The publication is in a language other than English.
The publication date is within the last five years The publication date is not within the last five years.
(2013-2018).
The publication describes a policy piece. The publication does not describe a policy piece.
The publication describes a study that takes The publication describes a study that takes place or
place in the United States or pertains to policy in pertains to policy in a country other than the United
the United States. States.

The publication focuses on a social, behavioral, The publication is not focused on a social, behavioral,
or environmental determinant of health factor (as or environmental determinant of health factor; the
predictors). publication is focused on access to care or clinical care
without addressing a social, behavioral, or
environmental determinant.
The publication addresses the impact of digital The publication does not address the impact of
health technology (electronic health records, technology on social determinants of health.
artificial intelligence, machine-learning,
advanced analytics, patient portals) on social
determinants of health.
Note that priority will be given to more recently published articles in higher-tier journals, with
longer follow-up, larger sample sizes, and greater generalizability.