Development and validation of a community risk score for sexual and reproductive health in the United States

Abstract

Equitable access to sexual and reproductive health (SRH) care is key to reducing inequities in SRH outcomes. Publicly funded family-planning services are an important source of SRH care for people with social risk factors that impede their access. This study aimed to create a new index (Local Social Inequity in SRH [LSI-SRH]) to measure community-level risk of adverse SRH outcomes based on social determinants of health (SDoH). We evaluated the validity of the LSI-SRH scores in predicting adverse SRH outcomes and the need for publicly funded services. The data were drawn from more than 200 publicly available SDoH and SRH measures, including availability and potential need for publicly supported family planning from the Guttmacher Institute. The sample included 72 999 Census tracts (99.9%) in the 50 states and the District of Columbia. We used random forest regression to predict the LSI-SRH scores; 42 indicators were retained in the final model. The LSI-SRH model explained 81% of variance in the composite SRH outcome, outperforming 3 general SDoH indices. LSI-SRH scores could be a useful for measuring community-level SRH risk and guiding site placement and resource allocation.Accounting for an array of social factors, from poverty to housing, the novel Local Social Inequity in Sexual and Reproductive Health (LSI-SRH) score illuminates the deep-seated drivers of health outcomes, particularly in sexual and reproductive health. Based on machine-learning analysis of over 100 social determinants across US Census tracts, the LSI-SRH score shows remarkable predictive power, explaining approximately 81% of the variance in sexual and reproductive health outcomes. Health professionals can use the score to target interventions with greater precision, ensuring resources reach those with the most need. Policymakers, too, can leverage these insights to allocate funding and support effectively, paving the way for more equitable care.This paper introduces the Local Social Inequity in Sexual and Reproductive Health (LSI-SRH) score. It is a multipart measure that explores how social factors-such as wealth inequality, housing, and health care access-affect the health of communities, particularly in sexual and reproductive health outcomes. After analyzing social determinants across US neighborhoods, the researchers report that the LSI-SRH score accounts for a substantial amount of inequitable differences in health outcomes. The new risk score can be used to target interventions, influence resource distribution, and inform policy development. This research provides a tool with the potential to drive real change in terms of reducing health disparities and fostering equity.