Brief Review of Studies on Social Determinants of Health

As the topic of SDOH continues to gain traction, an increasing amount of research is being published, illuminating the significant impact of social determinants of health (SDOH) on clinical decision-making, patient outcomes, and healthcare costs across various medical domains. Here are a few studies we’ve bookmarked.

Measuring population health: association of self-rated health (SRH) and PROMIS measures with social determinants of health in a cross-sectional survey of the US population

Rubenstein and colleagues conducted a study comparing the effectiveness of SRH and PROMIS scores in assessing their association with SDOH. Their findings revealed that both SRH and PROMIS were able to detect statistically significant differences across various chronic conditions and SDOH factors. However, the PROMIS measure, with its 14-item questionnaire, exhibited a greater ability to detect nuanced differences in health-related quality of life concerning SDOH. This suggests the potential superiority of PROMIS over SRH in capturing the multifaceted nature of health outcomes influenced by social determinants. Utilizing comprehensive screening tools like PROMIS to better understand and address SDOH-related disparities in healthcare delivery is a core component of creating an equitable healthcare system.

Social Determinants of Health in Total Hip Arthroplasty: Are They Associated With Costs, Lengths of Stay, and Patient Reported Outcomes?

In the realm of orthopedic surgery, Delanois et al. investigates the impact of social determinants of health (SDOH) on predicting patient outcomes after total hip arthroplasty (THA). Their study reveals increased post-discharge costs in patients with a minority status,  living in a food desert, and those with inadequate transportation and housing. Outside of cost, the study found that having depression was linked to a longer Length of Stay (LOS).

None of the other SDOH or patient metrics had an impact on LOS and there were no observed connections between SDOH and changes in HOOS JR from baseline. The study serves to emphasize the need to address SDOH-related risk factors before surgery and highlights potential implications within bundled care models.

Social Determinants of Health and Patient-Reported Outcomes Following Total Hip and Knee Arthroplasty in Veterans

Rubenstein et al. conducted a thorough investigation into the impact of Social Determinants of Health (SDOH) on patient-reported outcomes following Total Joint Arthroplasty (TJA) among veterans. Their study, spanning across VHA Hospitals in Minneapolis, MN, Palo Alto, CA, and San Francisco, CA, involved the prospective collection of Patient-Reported Outcome Measures (PROMs). These measures, including the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were gathered both preoperatively and one year postoperatively. The results unveiled a troubling trend: minority hispanic and black veterans within the VHA system exhibited lower improvements in PROM scores following TJA compared to their white counterparts. In addition, the study concluded that education, gender, comorbidities, and neighborhood poverty were insignificant on outcomes. These findings prove the existence of significant disparities in post-operative recovery caused by SDOH factors.

National Evaluation of Social Determinants of Health in Orthopedic Fracture Care: Decreased Social Determinants of Health Is Associated With Increased Adverse Complications After Surgery

Kamalapathy et al.’s research delves into the impact of SDOH on orthopedic fracture care, revealing profound effects on post-operative complications and readmission rates following hip and ankle fracture management. Their study, covering patients aged 18-85 undergoing surgery for these fractures from 2010 to 2018, highlights the heightened risks faced by individuals with educational and economic disparities. Patients with educational deficiencies exhibit increased rates of readmission and major complications after surgery, while economic disparities correlate with elevated risks of readmission, revision surgery following hip fractures, and infection and readmission post-ankle fractures. These findings emphasize the urgent need for targeted interventions aimed at mitigating socioeconomic disparities in orthopedic care to ensure better patient outcomes.

Wrapping Up The Research

Collectively, these studies emphasize the critical role of SDOH in shaping clinical outcomes and healthcare utilization across diverse patient populations, highlighting the importance of integrating SDOH considerations into clinical practice.