Social Determinants Of Health Research Articles

Social Determinants of Health, Cardiovascular Health, and Mortality in Sexual Minority Individuals in the United States

Social Determinants of Health, Cardiovascular Health, and Mortality in Sexual Minority Individuals in the United States

Understanding Homelessness Experiences and Social Determinants of Health Among People Experiencing Homelessness Enrolled in Methadone Treatment

Understanding Homelessness Experiences and Social Determinants of Health Among People Experiencing Homelessness Enrolled in Methadone Treatment

Abstract WMP58: Social determinants of Health with Ischemic Stroke Patients treated with IV thrombolysis within a Public Safety Net Hospital

Abstract WMP58: Social determinants of Health with Ischemic Stroke Patients treated with IV thrombolysis within a Public Safety Net Hospital

Social determinants of health in the mucopolysaccharidoses

Social determinants of health in the mucopolysaccharidoses

A network analysis to explore illness perceptions in Black adults with type 2 diabetes.

This study explores the structure of beliefs about type 2 diabetes among Black adults and informs potential targets to reframe negative beliefs and enhance diabetes self-management. We applied network analysis to investigate the interrelated structure and clusters of beliefs about diabetes and identify specific items that could serve as behavioural targets. We obtained self-reported survey data from 170 Black adults with type 2 diabetes. Regularised partial correlation networks and a Gaussian graphical model were used to explore and visualise the interrelationship among 21 items of a culturally adapted Illness Perception Questionnaire-Revised. Overwhelming negative emotions representing the current and long-term effects of diabetes were central to the illness perceptions network among Black adults, with feeling depressed having the highest node strength of centrality indices in the network. Four beliefs had a bridging effect with the central cluster: diabetes taking away the ability to enjoy food, diabetes keeping me away from the job I want, being poor contributed to my having diabetes, and I receive encouragement from friends and family. In addition to highlighting the overwhelming feeling of diabetes, the illness perception network further differentiated the role of racial identity and social determinants of health as discrete, though both are related sociocultural influence constructs. To enhance self-management for Black adults with type 2 diabetes, this network informs promising intervention targets focused on culturally tailored education related to emotional regulation, internalised stigma and healthy food adaptation, and leveraging support to address social determinants of health.

Sex disparities in outcome of medication-assisted therapy of opioid use disorder: Nationally representative outpatient clinic data.

The opioid epidemic causes massive morbidity, and males have substantially greater overdose mortality rates than females. It is unclear whether there are sex-related disparities at different stages in the trajectory of opioid use disorders (OUD), from large samples in the community. To determine sex disparities in non-medical opioid use (NMOU) at the end of treatment with medications for opioid use disorder (MOUD), using national data. Observational study of outpatient MOUD programs in the "Treatment episode data set-discharges" (TEDS-D) for 2019. Persons aged ≥ 18 in their first treatment episode, in outpatient MOUD-based therapy for heroin or other opioids (N = 10,065). The binary outcome was presence/absence of NMOU in the month prior to discharge. In univariate analyses, males had higher odds of NMOU compared to females (odds ratio=1.22; p = 6.84 ×10-5 after Bonferroni correction). A multivariable logistic regression detected a relatively small male>female odds ratio of 1.14 (p = 0.0039), surviving adjustment for demographic variables and social determinants of health. Several specific conditions were revealed in which males had greater odds of NMOU compared to females (e.g., if they were in the white racial category, and were not of hispanic ethnicity). Also, using by smoking, inhalation or injection routes (versus oral) was associated with greater odds of NMOU, irrespective of sex. This national community sample shows that males overall have greater odds of NMOU in their first treatment episode with MOUD, a potential indicator of more unfavorable outcomes. Further analyses should examine the underpinnings of this disparity, including clinical severity features.

Maternal and Infant Outcomes in a Subset of Patients with Sickle Cell Disease in South Carolina.

Sickle cell disease (SCD), which disproportionately affects minorities, increases complications during pregnancy. Severe maternal mortality is increased in women with SCD, including morbidity related to the disease and other nondisease-related complications. It also can have devastating complications for fetuses, with increases in premature birth and low birth weight. This study aimed to describe the characteristics of women with SCD in South Carolina, with a specific focus on fetal and maternal outcomes and complications. The secondary aim of this study was to identify the effect of maternal characteristics on birth outcomes, including social determinants of health. A secondary analysis of women from a single institution, the Medical University of South Carolina, which was part of the registry from the multi-institutional Sickle Cell Disease Implementation Consortium, was conducted. Patient demographics, self-reported pregnancy history, hydroxyurea use, and maternal and fetal outcomes were collected from patient-reported survey data. In addition, the number of vaso-occlusive episodes surrounding their pregnancies was collected for analysis. Fifty-nine percent (116/195) of the female participants reported ever being pregnant. Seventy-two percent had live births, 15.8% had miscarriages, 1.8% had stillbirths, and 6.1% had an abortion. The mean age was 22.3 ± 4 years, with no difference in markers of severity between the groups. Most women were HbSS genotype with high rates of pain in the last year. No difference was found in age, education, employment, or income between these groups of women. Women in the nonlive birth cohort had higher body weights (78.7 versus 72.1 kg, P = 0.045). The Distressed Community Index was used as a marker for social determinants of health and was similar between the two groups, with a majority of both cohorts (61.7% and 52%) living in "at risk" and "distressed" communities. Complications related to SCD were high, including 43% of women experiencing pain during pregnancy, 5.2% developing acute chest syndrome, and 22.4% requiring transfusion. An additional 11% experienced preeclampsia. Unfavorable infant outcomes included 49% of the infants being premature and 40% having babies weighing less than 5.5 lb at birth. High rates of complications to both mother and infant were found in the women with SCD. Although few statistically significant predictors were found, by identifying and addressing specific needs of pregnant women with SCD, we can work toward reducing fetal and maternal mortality in an already vulnerable population.

Social determinants of health, Black race, sensitization to indoor molds and risk of severe asthma

Social determinants of health, Black race, sensitization to indoor molds and risk of severe asthma

Rehabilitation Management of Neck Pain-Development of a Diagnostic Framework Based on the Pain and Disability Drivers Management Model.

Neck pain is a major cause of disability worldwide, and current rehabilitation strategies show limited effectiveness. Subgrouping patients by their primary pain and disability drivers can help tailor treatments. At this end, the Pain and Disability Drivers Management (PDDM) was developed and has demonstrated preliminary effectiveness in the management of low back pain. Nevertheless, the PDDM model was only validated for this population. Adapting this framework to patients with neck pain would provide a more global view of the patient's experience of pain and support a genuine biopsychosocial intervention. The aim of this study was to develop and validate the content of the PDDM model for patients living with neck pain. Through a modified DELPHI study design, participants with clinical and research expertize in rehabilitation of neck pain were invited to participate. A questionnaire was developed using literature reviews and endorsed by a steering committee. The relevance of each element of the newly adapted model was evaluated on a 4-point Likert scale. An item reached consensus if it obtained the predefined threshold of > 78% "relevant" and "very relevant." Participants left comments on terminology and recommended items to add in early rounds. Quantitative and qualitative analyses were performed. An invitation was sent to 1650 potential participants, from which 155 accessed the survey, 64 completed the first round and 55 the second round. A total of 70 elements met consensus and were distributed across six domains: "Nociceptive pain drivers", "nociplastic pain drivers," "drivers associated with neuropathic pain","comorbidity drivers", "cognitive-emotional drivers"and "environmental or lifestyle drivers, and social determinants of health." Through a modified DELPHI study, the PDDM model was updated and adapted to people with neck pain. Subsequent steps include clinical integration and measures of efficacy when used for assessment/treatment.

Health disparities in HIV care and strategies for improving equitable access to care.

The US HIV/AIDS Strategy and Ending the HIV Epidemic (EHE) initiatives aim to reduce HIV transmission by 90% by 2030 through targeted care and prevention initiatives such as the Undetectable = Untransmittable strategy. Effective HIV management involves implementation of widely available testing to ensure early diagnosis, immediate or early initiation of antiretroviral therapy (ART), patient adherence to medication, and retention in care to achieve viral suppression and improve clinical outcomes. A disproportionate burden of HIV incidence is experienced by certain populations that include Black/African American and Hispanic/Latinx people, transgender individuals, those who inject drugs, older adults, and people living in the southeastern US. People with HIV (PWH) in vulnerable and underserved populations are more likely to be affected by the negative impacts of structural and social determinants of health-such as experiencing HIV-related stigma, poverty, and homelessness-resulting in barriers to accessing HIV care and achieving favorable treatment outcomes. Suboptimal HIV care negatively impacts outcomes for both individuals and society. Overall and comorbidity-free life expectancies are lower for individuals who start ART late than for the overall PWH population, and a lack of viral suppression increases community transmission rates. These poor outcomes increase costs for both patients and health care systems. Maintaining access to high-quality care by optimizing ART regimens, decreasing delays in ART initiation, and engaging patients in care by building trust and empowering patient choice will improve individual and population-level outcomes and support the EHE initiative. This manuscript examines strategies to improve HIV care access and outcomes for underserved populations, focusing on social determinants of health, stigma, geographic disparities, and treatment adherence, while highlighting the role of national initiatives and managed care programs in advancing health equity.

News Brief: Collection of information about social determinants of health.

News Brief: Collection of information about social determinants of health.

Examining the Association Between Public Health Accreditation and COVID-19 Outcomes.

To examine the association between local health department (LHD) accreditation and COVID-19 community outcomes, including rates of adult vaccination, hospitalization, and death. We examined county level rates of adult vaccination, hospitalization, and death by LHD accreditation status over the course of the COVID pandemic. Additional independent variables included time period, COVID-19 Community Vulnerability Index (CCVI), state public health governance structure, and state policy environment. We used hierarchal linear mixed modeling with random intercept for county level data to account for repeated observations and fixed effects for all other variables. This study examined all communities in the United States of America. LHDs and the communities they serve. Rates of adult vaccination, hospitalization, and death due to COVID-19. Among accredited LHDs, the adult population was more likely to be fully vaccinated when compared to unaccredited LHDs ( P <.01). Additional variables in the model, which were also significant, included time period, CCVI, state policy environment, and state public health governance structure. There were no significant differences in the hospitalization rates in jurisdictions with an accredited LHD compared to jurisdictions where the LHD is not accredited. Death rates in jurisdictions with an accredited LHD were statistically significantly lower than death rates in jurisdictions where the health department was not accredited ( P <.001). This relationship was significant with other key variables in the model, including time, CCVI, state policy environment, and state public health governance structure. This study demonstrates that there is an association between LHD accreditation and community health outcomes. Furthermore, we found that other factors, such as social determinants of health, state policy environment, and state public health governance structure impact community health outcomes.

Comprehensive analysis of socioeconomic and clinical factors contributing to treatment delay in early-onset colorectal cancer.

32 Background: The prevalence of early-onset colorectal cancers (EOCRC) is rising globally. Disparities in social determinants of health can delay access to treatment and impacting outcomes. This study aims to analyze factors influencing time from diagnosis to treatment among EOCRC patients in a racially diverse population, considering tumor factors and sociodemographics. Methods: We analyzed EOCRC data from patients diagnosed between 2000 and 2022 at Queen’s Medical Center in Honolulu, Hawaii. Time from diagnosis to treatment for Asians, Whites, and Native Hawaiian or Other Pacific Islanders (NHOPI) was assessed using the Kaplan-Meier Method. Cox proportional hazards regression models were used to identify predictors, adjusting for clinical and pathological factors. Results: A total of 379 patients were analyzed. NHOPI were more like to be underinsured compared to Whites and Asians. In the unadjusted Cox model, underinsured/uninsured status, older age, unknown stage, left sided, and rectal locations were associated with delayed treatment. After adjustment, underinsured/uninsured status, older age, and rectal location remained significant predictors of delayed treatment. Conclusions: EOCRC patients with underinsured/uninsured status, age, and rectal tumor location are significantly associated with delayed in cancer treatment. While age was statistically significant, its clinical impact appears minimal. The need for a multidisplinary approach and additional preoperative staging in rectal cancer may explain treatment delays even after adjustment. Improving treatment accessibility and reducing delays, especially for underinsured EOCRC patients, is important. Univariate and multivariate analysis of time from diagnosis to treatment. Univariate Multivariate HR (95% CI) p-value HR (95% CI) p-value Insurance - - - - Private insurance - - - - Underinsured/Uninsured 0.692 (0.545-0.878) 0.003 0.706 (0.55-0.906) 0.006 Race White - - - - Asian 0.912 (0.696-1.195) 0.503 0.817 (0.619-1.077) 0.151 NHOPI 0.749 (0.548-1.025) 0.071 0.779 (0.562-1.08) 0.134 Age 0.978 (0.96-0.997) 0.021 0.968 (0.949-0.987) 0.001 Histopathology grade Grade 1&amp;2 - - - - Grade 3&amp;4 1.046 (0.798-1.371) 0.746 1.083 (0.813-1.441) 0.587 Stage 1 - - - - 2 1.022 (0.718-1.456) 0.902 1.071 (0.744-1.539) 0.713 3 1.227 (0.896-1.682) 0.203 1.387 (0.997-1.931) 0.052 4 0.964 (0.673-1.381) 0.842 1.039 (0.716-1.507) 0.842 Unknown 0.631 (0.406-0.981) 0.041 0.748 (0.473-1.182) 0.213 Sex Male - - - - Female 1.029 (0.836-1.267) 0.785 1.072 (0.868-1.325) 0.518 Microsatellite status Stable - - Unstable 1.074 (0.616-1.875) 0.8 Not done/Unknown 1.259 (1.004-1.577) 0.046 Location of Tumors Right - - - - Left 0.631 (0.468-0.851) 0.003 0.735 (0.535-1.011) 0.058 Rectal 0.43 (0.317-0.582) &lt;0.001 0.448 (0.327-0.613) &lt;0.001 NHOPI: Native Hawaiians and Other Pacific Islanders. HR: Hazard Ratio CI: Confidence Interval.

771 Associations between social determinants of health, obesity, and sleep health in federally qualified health center patients in Louisiana

771 Associations between social determinants of health, obesity, and sleep health in federally qualified health center patients in Louisiana

Social Determinants of Health Among Top Suicide Risks

Social Determinants of Health Among Top Suicide Risks

The Social Security Fairness Act: Evaluating Potential Impact, Limitations, and Implications for Research, Policy, and Practice.

The impact of laws and policies that involve social determinants of health (SDOH), particularly among older, retired populations, needs to be considered as a public health intervention. The Social Security Fairness Act was signed into law in 2025, as a new amendment to the Social Security Act first introduced in 1935. The Social Security Fairness Act ends two provisions that have reduced benefits for spouses, widows, and widowers and for public service workers, which include teachers, fire fighters, police officers, nurses, and others who are receiving pensions from state or local government. Specifically, this new bill involves economic stability, which is considered an important SDOH for older adults. The purpose of the current article is to evaluate policy changes through the Social Security Fairness Act, including potential impact and benefits, limitations or unintended consequences, and implications and recommendations for future research, policy, and practice. Findings will help guide gerontological nurses and interprofessional researchers, clinicians, and educators promoting healthy aging. [Journal of Gerontological Nursing, 51(2), 7-12.].

A scoping review and expert consensus on digital determinants of health.

To map how social, commercial, political and digital determinants of health have changed or emerged during the recent digital transformation of society and to identify priority areas for policy action. We systematically searched MEDLINE, Embase and Web of Science on 24 September 2023, to identify eligible reviews published in 2018 and later. To ensure we included the most recent literature, we supplemented our review with non-systematic searches in PubMed® and Google Scholar, along with records identified by subject matter experts. Using thematic analysis, we clustered the extracted data into five societal domains affected by digitalization. The clustering also informed a novel framework, which the authors and contributors reviewed for comprehensiveness and accuracy. Using a two-round consensus process, we rated the identified determinants into high, moderate and low urgency for policy actions. We identified 13 804 records, of which 204 met the inclusion criteria. A total of 127 health determinants were found to have emerged or changed during the digital transformation of society (37 digital, 33 social, 33 commercial and economic and 24 political determinants). Of these, 30 determinants (23.6%) were considered particularly urgent for policy action. This review offers a comprehensive overview of health determinants across digital, social, commercial and economic, and political domains, highlighting how policy decisions, individual behaviours and broader factors influence health by digitalization. The findings deepen our understanding of how health outcomes manifest within a digital ecosystem and inform strategies for addressing the complex and evolving networks of health determinants.

Disparities in incidence and mortality of colorectal cancer in Appalachian Kentucky.

33 Background: Since the late 1990s, both the incidence and mortality of invasive colorectal cancer (CRC) have decreased across the United States, including in Kentucky. Despite this, CRC incidence and mortality are above national average in Kentucky. Over the last two decades, a disparity in CRC incidence and mortality has emerged between Appalachian Kentucky (AK), a distinct eastern region, and Non-Appalachian Kentucky (NAK). This disparity is attributed to differences in social and structural determinants of health (SSDH) between these populations. Methods: Age-adjusted CRC incidence and mortality rates (2016-2020) for both Kentucky and the U.S. were obtained from the National Cancer Institute’s public database. Data from the Kentucky Cancer Registry were used to compare CRC incidence and mortality rates in AK and NAK counties from 1994-2021. Incidence rate ratio analyses across discrete time periods demonstrated statistical differences between these regions. Results: Compared to national data (2016-2020), Kentucky's CRC age-adjusted incidence and mortality rates were significantly higher: 45.9 vs. 36.5/100,000, 25.8%, for incidence, and 16.2 vs. 13.1/100,000, 23.7%, for mortality (both p&lt;0.0001). From 1995-2003 incidence and 1994-2003 mortality of CRC, were higher in NAK, these rates eventually decreased and equalized between NAK and AK. By 2010-2015 both incidence and mortality rates were higher in AK, 55.8 vs 48/100,000, 16.3%, (p=&lt;0.0001) and 20.1 vs 15.8/100,000, 27.2%, (p=&lt;0.0001) respectively. The most recent data (2016-2021) shows that these significant disparities persist, with AK’s incidence and mortality 51.8 vs 44.1/100,000, 17.5% (p=&lt;0.0001) and mortality 19.0 vs 15.1/100,000, 25.8% (p=&lt;0.0001) higher, respectively. Conclusions: While CRC rates have decreased nationwide and in Kentucky, a pronounced gap in both incidence and mortality has developed between Appalachian and Non-Appalachian Kentucky. Appalachian counties—which are more rural and impoverished—face greater barriers to accessing preventive healthcare, contributing to this disparity. Additionally, AK has higher rates of obesity, poverty, smoking, and lower educational attainment and screening rates . Recent public health efforts, such as promoting stool-based screening and increasing preventive care discussions, aim to reduce these disparities. However, delays in CRC screenings during the COVID-19 pandemic— resulting in approximately 1.7 million missed colonoscopies nationally— may have skewed the most recent data, necessitating further analysis in the coming years.

An Argument for More High-Quality Research Focused on Mental Health in the Post-Secondary Context.

We argue that while a substantial proportion of emerging adults are in post-secondary education, there is relatively little consideration of this context within research and policy around youth mental health. The unique challenges young adults face in post-secondary education overlay underlying risk factors experienced by emerging adults. While post-secondary education facilitates social mobility, it also introduces stressors such as academic demands, financial insecurity and social isolation. As we increasingly appreciate the social determinants of mental health and the influence of institutional systems, understanding the post-secondary context offers promise in transforming mental health in emerging adulthood. There are pockets of great practice. However, we argue that targeted efforts are now needed to bring together students, practitioners, policymakers and researchers to drive evidence-informed improvements in mental health within the post-secondary context.

US State and Territorial Indigenous Consultation Laws: A Potential Strategy to Improve the Social Determinants of Health.

The United Nations (UN) has articulated the right to self-determination as a human right for Indigenous people; however, US states and territories have been slow to operationalize this aspect of the UN Declaration on the Rights of Indigenous Peoples. Indigenous consultation laws require all federal executive agencies to consult with tribal nations before implementing policies that have a "tribal implication," and these form the cornerstone of US efforts to implement the UN Declaration on the Rights of Indigenous Peoples. Despite these federal efforts, less is known about the degree to which state and territorial laws require consultation with Indigenous communities. We reviewed all Indigenous consultation laws identified through a search of 50 US states, the District of Columbia, and 5 territories to provide a holistic picture of how jurisdictions have regulated Indigenous consultation efforts. Of the 56 states, 49 (87.5%) had at least 1 Indigenous consultation law; the remaining 7 jurisdictions had none. States engaged in Indigenous consultation in various ways, generally falling into 1 of 3 categories: (1) centralized consultation facilitated through an agency or department, (2) indirect consultation through a designated commission, and (3) fragmented Indigenous consultation through discrete laws. Important gaps were identified, including the lack of a definition for Indigenous consultation, the absence of an appeal process, and the need to train state officials on existing policies. The results provide a baseline on the degree to which US states and territories consult with Indigenous communities and can be used to identify gaps in US compliance with UN human rights mandates.