This article examines associations between cumulative adverse financial circumstances and
patient health in a sample of 1,506 urban emergency department (ED) patients. Study
participants completed a previously validated Social Health Survey between May and October
2009. Five categories of economic deprivation were studied: food insecurity, housing concerns,
employment concerns, cost-related medication nonadherence, and cost barriers to accessing
physician care. Logistic regression that adjusted for the effects of demographics (age, gender,
race, education) tested the association between the cumulative number of adverse financial
circumstances (range: 0 to 5) and patients' health status (self-rated health, stress level, depressed
mood) and health behaviors (smoking and substance abuse). Approximately 48 percent of
respondents reported one or more fmancial concern, and 31 percent reported two or more
financial concerns. A significant graded relationship was found between the number of adverse
financial circumstances and patients' poor/fair self-rated health, depressed mood, high stress,
smoking, and illicit drug use. Findings suggest that in today's acute health safety net, patients'
concerns related to financial insecurity are very relevant to patient health. This underscores
the imperative for hospital-based social workers to design models of routine social health risk
screening and system interventions that address patient financial well-being in the ED.