Social Determinants Of Health Research Articles

Development and Unfolding of the Life Course Movement in the Field of Maternal and Child Health: An Oral History.

A life course perspective in maternal, child, and family health allows for integrated exploration of outcomes, incorporating multifactorial determinants of health to interrogate sources of inequity and identify opportunities for intervention. This article explores the historical development, integration, and implications of the contemporary life course perspective in the field of maternal and child health (MCH), and particularly the people and events which institutionalized the framework as central to national and local MCH practice and research over the last decades. Drawing on an oral history approach, key leaders of the life course movement in MCH were interviewed. Lived experiences and personal recollections of six interviewees were recorded and synthesized using a narrative descriptive approach to portray the social ecology of the movement's origins. We documented systematic efforts made in the first two decades of the 21st century to consciously promote life course through convening a National MCH Life Course Invitational Meeting, incorporating life course as a foundational framework for strategic planning at the Maternal Child Health Bureau, and development of tools and resources by MCH professional organizations. The integration of life course theory into the MCH field signified a major shift towards addressing protective and social factors, which aligns with the field's historical emphasis on social justice and rights-based approaches, and parallels the broader public health movement towards social determinants of health and the need to address structural racism. The ongoing relevance of the life course approach in promoting reproductive justice and addressing inequities in health underscores the historical importance of its adoption and use in the current mainstream of MCH research, policy, and practice.

Enrolling High-Acuity Emergency General Surgery Patients in a Prospective Longitudinal Cohort Study.

Over three million patients are admitted to hospitals annually with high-acuity conditions mandating emergency abdominal or skin/soft-tissue operation. Patients with these high-acuity emergency general surgery (HA-EGS) diseases experience significant morbidity/mortality, yet the quality of life (QOL) impact on survivors is not well studied. Acuity, transfer patterns, and adverse social determinants of health (SDOH) documented in epidemiologic studies are cited reasons for inability to measure patient-reported outcomes (PROs) among HA-EGS survivors. We conducted a feasibility study to understand facilitators and barriers of conducting a prospective study of changes in QOL after surviving HA-EGS. From September 2019 to April 2021, we collected baseline (pre-admission) and 30/60-days post-surgery data on activities of daily living, depression, self-efficacy, resilience, pain, work limitations, social support, and substance use from patients who enrolled during index hospitalization. 100 patients were consented to participate in the study (71.9% enrollment rate). The retention rate was 65.9% for 30-day calls and 53.8% for 60-day calls. Median time to complete each time point remained under 25 minutes. Patients with a longer length of stay and nicotine users didn't complete their 30-day interview while those with systemic complications didn't complete their 60-day interview. These results set the foundation for future PRO studies.

Psychosocial Determinants Conferring Resilience after TBI: Current Understanding

Abstract Purpose of review Traumatic Brain Injury (TBI) is a complex condition, with outcomes ranging from profound disability to remarkable recovery. Considerable variability in outcomes is observed, even among those with similar injury mechanisms, severity and neuropathological pattern. This indicates a need to explore resilience factors influencing TBI recovery. Recent findings This narrative review synthesizes existing literature, focusing on individual, social, and community factors impacting resilience post-TBI. Recent research highlights how individual factors such as personality traits, coping strategies, and premorbid psychiatric history, as well as social and contextual factors, like social support and social determinants of health (SDoH) all impact TBI recovery. We also discuss clinical applications of resilience-focused interventions to promote health and wellbeing after TBI. Summary An improved understanding of resilience factors and pathways to recovery post-TBI is crucial for optimizing outcomes. Future research should focus on developing comprehensive interventions addressing individual, social, and community-level factors to foster resilience and enhance TBI recovery.

The health risk of social disadvantage is transplantable into a new host

Low socioeconomic status (SES) is a risk factor for mortality and immune dysfunction across a wide range of diseases, including cancer. However, cancer is distinct in the use of allogeneic hematopoietic cell transplantation (HCT) as a treatment for hematologic malignancies to transfer healthy hematopoietic cells from one person to another. This raises the question of whether social disadvantage of an HCT cell donor, as assessed by low SES, might impact the subsequent health outcomes of the HCT recipient. To evaluate the cellular transplantability of SES-associated health risk, we analyzed the health outcomes of 2,005 HCT recipients who were transplanted for hematologic malignancy at 125 United States transplant centers and tested whether their outcomes differed as a function of their cell donor's SES (controlling for other known HCT-related risk factors). Recipients transplanted with cells from donors in the lowest quartile of SES experienced a 9.7% reduction in overall survival (P = 0.001) and 6.6% increase in treatment-related mortality within 3 y (P = 0.008) compared to those transplanted from donors in the highest SES quartile. These results are consistent with previous research linking socioeconomic disadvantage to altered immune cell function and hematopoiesis, and they reveal an unanticipated persistence of those effects after cells are transferred into a new host environment. These SES-related disparities in health outcomes underscore the need to map the biological mechanisms involved in the social determinants of health and develop interventions to block those effects and enhance the health of both HCT donors and recipients.

Systematic review of disparities in continuous glucose monitoring and insulin pump utilization in the United States: Key themes and evidentiary gaps.

This study aims to provide a comprehensive overview of real-world evidence pertaining to disparities in the utilization of continuous glucose monitors (CGMs)/insulin pumps to highlight potential evidentiary gaps and discern emerging themes from the literature. A systematic review of published manuscripts and abstracts was conducted from: MEDLINE, EMBASE, Nursing and Allied Health, Web of Science and CINHAL. Attributes related to patients, outcomes, interventions (CGMs/pumps/both) and study type were captured. In addition, factors associated with disparities in device utilization were examined. Thirty-six studies were included in the final analysis; the studies predominantly focused on people living with type 1 diabetes. Only two studies included individuals with type 2 diabetes. Almost two-thirds of the studies reported outcomes associated with disparities (e.g. glycated haemoglobin, diabetic ketoacidosis, resource utilization). Most studies highlighted disparities across race, ethnicity and insurance type. Evidentiary gaps were identified, particularly in the evidence for people with type 2 diabetes, the continuation of CGM/pump use and limited studies addressing disparities among Native Americans/American Indians. This study reveals critical disparities in diabetes technology use across race, ethnicity and insurance type, particularly among people with type 1 diabetes. Evidentiary gaps assessing disparities in diabetes technology use persist, particularly concerning people with type 2 diabetes, Native American/American Indian and LGBTQ+ populations, and in outcomes related to continuation of use. Social and digital determinants of health, such as income, transportation, residential location and technological literacy, are crucial to achieving equitable access. Future research should focus on the patient journey to identify opportunities for equitable access to diabetes technology as its use grows.

Neighborhood Poverty and Clinic Attendance in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program.

Higher neighborhood-level poverty is associated with greater odds of missing a free eye disease screening appointment, underscoring the importance of community-based interventions to address upstream social determinants of health. To investigate the association between neighborhood-level characteristics and attendance for a free eye disease screening. The MI-SIGHT program is conducted in two community clinics in Southeastern Michigan. Participant-level demographics were extracted from electronic health records. Neighborhood level-characteristics including Area Deprivation Index (ADI), median household income (HHI), percent of households with >30% rent burden, percent of households without vehicles, percent of households in subsidized housing, and energy burden were obtained from the Wisconsin Neighborhood Atlas and the United States census. Logistic regression was used to model the probability of clinic visit attendance, which was the main outcome measure. 1431 participants were scheduled for screening appointments between July 2020 to November 2021, with a no-show rate of 23%. Individuals lived an average of 7.7 miles from each clinic (SD=8.1) and in neighborhoods with a mean ADI of 6.8 (SD=3.2, 1-10 scale where 10 is the most deprived). After adjusting for age, sex, race, and ethnicity, participants from neighborhoods with higher deprivation were more likely to have missed clinic visits. For example, there was an 8% higher odds of missed clinic visits for every 1-point increase in ADI (odds ratio, OR=1.08, P=0.020) and an 18% higher odds of a missed visit with every 10% increase in households without a vehicle (OR=1.18, P=0.013). Higher neighborhood-level poverty was associated with greater odds of missing a free eye disease screening appointment after adjusting for individual characteristics. Increased neighborhood-level resources are likely needed to bolster engagement in preventive eye care.

Model-based estimation of individual-level social determinants of health and its applications in All of Us.

We introduce a widely applicable model-based approach for estimating individual-level Social Determinants of Health (SDoH) and evaluate its effectiveness using the All of Us Research Program. Our approach utilizes aggregated SDoH datasets to estimate individual-level SDoH, demonstrated with examples of no high school diploma (NOHSDP) and no health insurance (UNINSUR) variables. Models are estimated using American Community Survey data and applied to derive individual-level estimates for All of Us participants. We assess concordance between model-based SDoH estimates and self-reported SDoHs in All of Usand examine associations with undiagnosed hypertension and diabetes. Compared to self-reported SDoHs, the area under the curve for NOHSDP is 0.727 (95% CI, 0.724-0.730) and for UNINSUR is 0.730 (95% CI, 0.727-0.733) among the 329074 All of Us participants, both significantly higher than aggregated SDoHs. The association between model-based NOHSDP and undiagnosed hypertension is concordant with those estimated using self-reported NOHSDP, with a correlation coefficient of 0.649. Similarly, the association between model-based NOHSDP and undiagnosed diabetes is concordant with those estimated using self-reported NOHSDP, with a correlation coefficient of 0.900. The model-based SDoH estimation method offers a scalable and easily standardized approach for estimating individual-level SDoHs. Using the All of Us dataset, we demonstrate reasonable concordance between model-based SDoH estimates and self-reported SDoHs, along with consistent associations with health outcomes. Our findings also underscore the critical role of geographic contexts in SDoH estimation and in evaluating the association between SDoHs and health outcomes.

Chasing cancer: does the social-to-medical spending ratio relate to cancer incidence and mortality in Canadian provinces? A retrospective cohort study

IntroductionCancer is the leading cause of death in Canada, and cases are expected to rise by 83% between 2012 and 2042. Jurisdictions with higher ratios of social-to-medical spending exhibit better...

Reducing racial and ethnic disparities in cardiovascular outcomes among cancer survivors.

Analyze current evidence on racial/ethnic disparities in cardiovascular outcomes among cancer survivors, identifying factors and proposing measures to address health inequities. Existing literature indicates that the Black population experiences worse cardiovascular outcomes following the diagnosis of both initial primary cancer and second primary cancer, with a notably higher prevalence of cardio-toxic events, particularly among breast cancer survivors. Contributing socioeconomic factors to these disparities include unfavorable social determinants of health, inadequate insurance coverage, and structural racism within the healthcare system. Additionally, proinflammatory epigenetic modification is hypothesized to be a contributing genetic variation factor. Addressing these disparities requires a multiperspective approach, encompassing efforts to address racial disparities and social determinants of health within the healthcare system, refine healthcare policies and access, and integrate historically stigmatized racial groups into clinical research. Racial and ethnic disparities persist in cardiovascular outcomes among cancer survivors, driven by multifactorial causes, predominantly associated with social determinants of health. Addressing these healthcare inequities is imperative, and timely efforts must be implemented to narrow the existing gap effectively.

ASO Visual Abstract: Open Versus Minimally Invasive Nephroureterectomy: Contemporary Analysis from a Wide National Population-Based Database.

Contemporary trend analysis of a large national data set confirms the occurrence of a significant shift toward minimally invasive nephroureterectomy (MINU), which is gradually replacing open nephroureterectomy (ONU). A minimally invasive approach is associated with a lower risk of complications. Social determinants of health (SDOH) are non-clinical factors that ultimately may have an impact on the outcomes of the nephroureterectomy (NU) procedure ( https://doi.org/10.1245/s10434-024-15565-6 ).

Racial and Ethnic Disparities Within Social Determinants of Health Amongst Patients With Systemic Lupus Erythematosus

Racial and Ethnic Disparities Within Social Determinants of Health Amongst Patients With Systemic Lupus Erythematosus

EPIC-CP pilot trial study protocol: a multicentre, randomised controlled trial investigating the feasibility and acceptability of social prescribing for Australian children with cerebral palsy

IntroductionThe social determinants of health contribute to poorer health outcomes for children with cerebral palsy (CP) and are barriers to families accessing health services. At an individual level, social determinants...

S54 - Social Determinants of Health and Quality of Care Among Patients With Opioid Use Disorder Receiving Treatment in Rural Primary Care Settings

S54 - Social Determinants of Health and Quality of Care Among Patients With Opioid Use Disorder Receiving Treatment in Rural Primary Care Settings

W74 - A Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People who Use Drugs

W74 - A Mobile Health Tool to Capture Social Determinants of Health and Their Impact on HIV Treatment Outcomes Among People who Use Drugs

Synergistic effects of social determinants of health and race-ethnicity on 30-day all-cause readmission disparities: a retrospective cohort study

ObjectiveThe objective of this study is to assess the effects of social determinants of health (SDOH) and race-ethnicity on readmission and to investigate the potential for geospatial clustering of patients...

Multivariate Analysis of Factors Associated with Feeding Mother's Own Milk at Discharge in Preterm Infants: A Retrospective Cohort Study.

This study aimed to develop a predictive model of feeding mother's own milk (MOM) at discharge using social determinants of health (SDOH), maternal and neonatal factors after deliveries at <33 weeks of gestational age (GA), or birth weight <1,500 g. Secondary analysis of a retrospective cohort in an inner-city hospital before (Epoch-1, 2018-2019) and after (Epoch-2, 2020-2021) implementing a donor human milk (DHM) program. Among 986 neonates, 495 were born in Epoch-1 (320 Hispanic White, 142 Non-Hispanic Black, and 33 Other) and 491 in Epoch-2 (327, 137, and 27, respectively). Feeding any MOM was less frequent in infants of non-Hispanic Black mothers than in those of Hispanic mothers (p < 0.05) but did not change with epoch (p = 0.46). Among infants who received any MOM, continued feeding MOM to the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers, 94/237 (40%) versus 339/595 (57%; p < 0.05), respectively. In multivariate analysis including SDOH and maternal variables, the odds of feeding MOM at discharge were lower with SDOH including neighborhoods with higher poverty levels, multiparity, substance use disorder, non-Hispanic Black versus Hispanic and young maternal age and increased with GA but did not change after implementing DHM. The predictive model including SDOH, maternal and early neonatal variables had good discrimination (area under the curve 0.85) and calibration and was internally validated. It showed the odds of feeding MOM at discharge were lower in infants of non-Hispanic Black mothers and with feeding DHM, higher need for respiratory support and later initiation of feeding MOM. Feeding MOM at discharge was associated with SDOH, and maternal and neonatal factors but did not change after implementing DHM. Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of feeding MOM but not by later initiation of feeding MOM. · In this cohort study of preterm infants, factors of feeding MOM at discharge included (1) SDOH; (2) postnatal age at initiation of feeding MOM; and (3) maternal and neonatal factors.. · Feeding MOM at the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers.. · Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of MOM feeding but not by later postnatal age at initiation of feeding MOM..

ACPM Position Statement: Air Pollution & Environmental Justice

The American Lung Association's “State of the Air” 2023 report reveals almost 36% of Americans live with unhealthy levels of air pollution. Studies link air pollution with acute respiratory symptoms and exacerbation of respiratory and cardiovascular diseases. Differential air pollution exposures between white and non-white communities are significant components of environmental injustices. Even during the COVID-19 lockdown, when the United States experienced significant decreases in polluting activities, these differences persisted. The American College of Preventive Medicine's Science and Translation Committee conducted a nonsystematic literature review to explore initiatives addressing air pollution as a key component of environmental justice, the state of the science regarding health impacts, and evidence supporting mitigations to reduce those impacts. We recommend advocacy for cleaner energy sources and increasing green space; and increasing research, surveillance, and education and training on linkages between air pollutants and health. We recommend preventive medicine physicians raise awareness about increased risks of cardiovascular disease, cancer, asthma, and reduced lung function with air pollution exposure. Preventive medicine physicians may also educate patients and other practitioners about exposures, and how “conventional” disease prevention strategies may have unintended consequences; and influence healthcare leaders to improve efficiency and reduce emissions. We also recommend physicians utilize social determinants of health (SDOH) Z-Codes to capture environmental factors. Private payers should incorporate pollution exposure data into SDOH risk-adjustments for Medicare Advantage programs. Medicaid agencies should develop provider recommendations for pediatric populations, and states should finance in-home interventions for asthma.

Nancy Elinor Adler (1946-2024).

Nancy was born in Manhattan in 1946. As a young girl, she was charmed by books about the teenage detective Nancy Drew and felt the books gave her an indelible enthusiasm for solving mysteries. Nancy graduated from Wellesley College (1968) and received her PhD from Harvard (1973) in social psychology. An APA Fellow, Nancy is one of the most cited scientists (top 0.1%) in the world (2022, Clarivate). She was a pioneer who shaped several key movements, including defining the field of Health Psychology, and deepening global recognition of social determinants of health. She won numerous honors and awards, including the David Rall Medal from the National Academy of Medicine. Nancy died at 77 at her home, on January 4, 2024, surrounded by loving family. The UCSF Center for Health and Community is establishing an annual Nancy Elinor Adler Endowed Lectureship Award for scholars who "illuminate the field of social and health disparities and conduct meaningful interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Receipt of parenting, disability, unemployment, and other income support payments in persons aged 16 to 33 years – the associations with child maltreatment

BackgroundChild maltreatment (CM) is a major public health concern with life-long effects. Its impact on income support has rarely been studied. ObjectiveTo examine the association between CM and receipt of income support payments and the budgetary impact for persons 16 to 33 years. Participants and settingA South Australian birth cohort, born 1986 to 2004 (n = 339,411). MethodsWe linked child protection (CP) administrative records with national welfare payment records, ending March 2020. Receipt of income support payments and mean payment amounts were described by CP contact (adjusted for child and family attributes). Budget impact was modelled at the national level. ResultsAdjusted odds ratio (AOR) for receipt of any income support payment was 3.01 (2.95–3.07) for individuals with any CP contact versus no CP contact. Among those receiving any payment, adjusted annualised mean benefit payment was $3754 (US$1446) among individuals with no CP contact, $6262 (US$4,307) in persons with any CP contact, and $9,747 in persons who'd been in OOHC. Cumulative payments modelled from age 16 to 33 years totalled $38,570 (US$26,652) for individuals with no CP contact, and $181,743 (US$125,003) for individuals who'd been in OOHC. Modelled for the Australian population to age 33, the extra cost associated with CP contact added 39 % to the government income support budget. ConclusionCM is strongly associated with receipt of income support payments. Investment in effective preventive and protective strategies for CP involved children could address this core social determinant of health, while providing budget savings.

Enhancing Sepsis prognosis: Integrating social determinants and demographic variables into a comprehensive model for critically ill patients

BackgroundThe Sequential Organ Failure Assessment (SOFA) score monitors organ failure and defines sepsis but may not fully capture factors influencing sepsis mortality. Socioeconomic and demographic impacts on sepsis outcomes have been highlighted recently. ObjectiveTo evaluate the prognostic value of SOFA scores against demographic and social health determinants for predicting sepsis mortality in critically ill patients, and to assess if a combined model increases predictive accuracy. MethodsThe study utilized retrospective data from the MIMIC-IV database and prospective external validation from the Penn State Health cohort. A Random Forest model incorporating SOFA scores, demographic/social data, and the Charlson Comorbidity Index was trained and validated. FindingsIn the MIMIC-IV dataset of 32,970 sepsis patients, 6,824 (20.7%) died within 30 days. A model including demographic, socioeconomic, and comorbidity data with SOFA scores improved predictive accuracy beyond SOFA scores alone. Day 2 SOFA, age, weight, and comorbidities were significant predictors. External validation showed consistent performance, highlighting the importance of delta SOFA between days 1 and 3. ConclusionAdding patient-specific demographic and socioeconomic information to clinical metrics significantly improves sepsis mortality prediction. This suggests a more comprehensive, multidimensional prognostic approach is needed for accurate sepsis outcome predictions.