Social Determinants Of Health Disparities Research Articles

Assessing social disparities in inpatient vs. outpatient arthroplasty: a in-state database analysis.

Given the growing emphasis on patient outcomes, including postoperative complications, in total joint arthroplasty (TJA), investigating the rise of outpatient arthroplasty is warranted. Concerns exist over the safety of discharging patients home on the same day due to increased readmission and complication rates. However, psychological benefits and lower costs provide an incentive for outpatient arthroplasty. The influence of social determinants of health disparities on outpatient arthroplasty remains unexplored. One metric that assesses social disparities, including the following individual components: socioeconomic status, household composition, minority status, and housing and transportation, is the Social Vulnerability Index (SVI). As such, we aimed to compare: (1) mean overall SVI and mean SVI for each component and (2) risk factors for total complications between patients undergoing inpatient and outpatient arthroplasty. Patients who underwent TJA between January 1, 2022 and December 31, 2022 were identified. Data were drawn from the Maryland State Inpatient Database (SID). A total of 7817 patients had TJA within this time period. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). The mean SVI was compared between inpatient and outpatient procedures for each themed score. The SVI identifies communities that may need support cause by external stresses on human health based on four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. The SVI uses the United States Census data to rank census tracts for each individual theme, as well as an overall social vulnerability score. The higher the SVI, the more social vulnerability, or resources needed to thrive in that area. Multivariate logistic regression analyses were performed to identify independent risk factors for total complications following TJA after controlling for risk factors and patient comorbidities. Total complications included: infection, aseptic loosening, dislocation, arthrofibrosis, mechanical complication, pain, and periprosthetic fracture. Patients who had inpatient arthroplasty had higher overall SVI scores (0.45 vs. 0.42, P < 0.001). The SVI scores were higher for patients who had inpatient arthroplasty for socioeconomic status (0.36 vs. 0.32, P < 0.001), minority status and language (0.76 vs. 0.74, P < 0.001), and housing and transportation (0.53 vs. 0.50, P < 0.001) compared to outpatient arthroplasty, respectively. There was no difference between inpatient and outpatient arthroplasty for household composition and disability (0.41 vs. 0.41, P = 0.99). When controlling for comorbidities, inpatient arthroplasty [Odds Ratio (OR) 1.91, 95% Confidence Interval (CI) 1.23-2.95, P = 0.004], hypertension (OR 2.11, 95% CI 1.23-3.62, P = 0.007), and housing and transportation (OR 2.00, 95% CI 1.17-3.42, P = 0.012) were independent risk factors for total complications. Inpatient arthroplasty was associated with increased social disparities across several components of deprivation as well as an independent risk factor total complications following TJA. To the best of our knowledge, this study is the first to examine the negative repercussions of inpatient arthroplasty through the lens of social disparities and can target specific areas for intervention.

The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture.

Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries. PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs. Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures. The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.

Social determinants of health disparities in Staten Island compared with Manhattan, Queens, Brooklyn, and the Bronx: Contribution to COVID-19 outcomes.

Social determinants of health (SDH) negatively affectedCoronavirus disease-2019 (COVID-19) outcomes within the five boroughs of New York City. The goal of this study was to determine whether differences in social demographics within the borough of Staten Island, compared with the other four boroughs, may have contributed to poor COVID-19 outcomes in Staten Island. Data were obtained from public data sources. Social demographics obtained included age, household income, poverty status, and education level. COVID-19 infection, hospitalization, and death rates reported from Staten Island were compared with rates from Manhattan, Queens, Brooklyn, and the Bronx (February 29, 2020-October 31, 2022). Mean differences in case rates of COVID-19 were higher in Staten Island compared to all four boroughs. Mean differences in hospitalization and death rates were higher than Manhattan but similar to the other four boroughs. Within Staten Island, case rates were highest in zip codes 10306 and 10309. Hospitalization and death rates were highest in Staten Island zip code 10304. We found that the zip codes of Staten Island with poorer COVID-19 outcomes had more individuals with less than a high school degree, lower mean household income, higher proportion of households earning less than $25,000 a year, and a greater proportion of individuals using public transportation. Differences in COVID-19 infection, hospitalization, and death rates exist between the five boroughs and between the 12 zip codes within Staten Island. These differences in COVID-19 outcomes can be attributed to different SDH.

Abstract A116: Assessment of equitable care for women of color with mBC

Abstract MD Anderson Cancer Center at Cooper in collaboration with The Chrysalis Initiative (TCI), sought to characterize the differences between the care that women of color (WOC) receive for metastatic breast cancer (mBC) compared to White women (WW), and understand the social determinants of health (SDOH) and palliative care (PC) needs that WOC with mBC face compared to WW. Twenty-eight WOC and 74 WW with mBC participated in an IRB approved telephone survey. The survey included questions on SDOH, understanding of PC, and the Edmonton System Assessment Scale which assesses symptoms common in cancer patients. WOC with mBC who participated tended to be less often married, more often had non-private insurance, and had lower educational levels and income. The only statistically significant response between the groups was that 50% of the WOC had ever heard of advance directives compared to 86.5% of WW (P&amp;lt;0.001). However, there were concerns for both groups including: 3 in 5 women had issues with lack of transportation to their appointments; 69% reported stress, nervousness, or anxiety; 78% were not following with a palliative care provider; 63% were dealing with pain; 59% were dealing with depression; 58% did not have a living will; 58% had not had an advanced directive discussed with them; 44% never heard of palliative care; and 40% had not had access to a social worker or nurse navigator. Also, TCI led 6 focus groups of women being treated for mBC at Cooper. Three focus groups comprised of 9 WOC with mBC, and 3 consisted of 15 WW with mBC. The goals of the focus groups were to gain insight into the factors influencing patient’s reasoning for their feelings towards the care they receive, and gain insight into the level of knowledge patients have about their breast cancer type, metastatic terminology, and other factors related to their journey. The themes identified suggest that important factors influence patients’ feelings about the care they receive including religion and faith, overall understanding of their treatment plan, willingness to research new treatment options on their own, and lifestyle and support systems that allow them to address and overcome barriers to care. WOC tended to have a poorer appreciation of their breast cancer disease and tumor characteristics and demonstrated lower health literacy or understanding of their mBC characteristics, and the relevance of these in their treatment plans. They had poorer knowledge of available support and palliative care resources and a higher incidence of feeling that they were not being listened to. Focus groups and surveys of women with mBC taught us that poor access to palliative care and social determinants of health disparities are prevalent for persons of color, and that having metastatic breast cancer is a burden for all ethnicities. Efforts need to continue to focus on educating WOC about their disease and its treatment. More importantly, we need to ensure that WOC have access to support services and opportunity to discuss their issues and concerns in a culturally competent manner. Citation Format: Evelyn Robles-Rodriguez, Ashley Weinmann, Generosa Grana, Jamil Rivers. Assessment of equitable care for women of color with mBC [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A116.

10557 Racial and Social Determinants of Health Disparities in Post-Operative Pain Following Gynecologic Laparoscopy

10557 Racial and Social Determinants of Health Disparities in Post-Operative Pain Following Gynecologic Laparoscopy

Social Determinants of Health Disparities Increase the Rate of Complications After Total Knee Arthroplasty

BackgroundFew studies have investigated whether social determinants of health disparities (SDHD), which include economic, social, education, health care, and environmental factors, identified through International Classification of Diseases (ICD) codes are associated with increased odds for poor health outcomes. We aimed to investigate the association between SDHD, identified through this novel methodology, as well as postoperative complications following total knee arthroplasty (TKA). MethodsUsing a national insurance claims database, a retrospective cohort analysis was performed. Patients were selected using Current Procedural Terminology and ICD codes for primary TKA between 2010 and 2019. Patients were stratified into 2 groups using ICD codes, those who had SDHD and those who did not, and propensity matched 1:1 for age, sex, a comorbidity score, and other comorbidities. After matching, 207,844 patients were included, with 103,922 patients in each cohort. Odds ratios (ORs) for 90-day medical and 2-year surgical complications were obtained using multivariable logistical regressions. ResultsIn patients who have SDHD, multivariable analysis demonstrated higher odds of readmission (OR): 1.12; P = .013) and major and minor medical complications (OR: 2.09; P < .001) within 90-days as well as higher odds of revision surgery (OR: 1.77; P < .001) and periprosthetic joint infection (OR: 1.30; P < .001) within 2-years. ConclusionThe SDHD are an independent risk factor for revision surgery and periprosthetic joint infection after TKA. In addition, SDHD is also an independent risk factor for all-cause hospital readmissions and both minor and major complications. Level of EvidenceIII.

Social determinants of health disparities impact postoperative complications in patients undergoing total shoulder arthroplasty

Understanding the role of social determinants of health disparities (SDHD) in surgical outcomes can better prepare providers to improve postoperative care. In this study, we utilize International Classification of Diseases (ICD) codes to identify SDHD and investigate the risk of postoperative complication rates among patients undergoing total shoulder arthroplasty (TSA). A retrospective cohort analysis was conducted using a national insurance claims database. Using ICD and Current Procedural Terminology (CPT) codes patients who underwent primary TSA with at least two years of follow-up in the database were identified. Patients with a history of SDHD were identified using appropriate ICD-9 and ICD-10 codes. Patients were grouped in one of two cohorts: (1) patients with no history of SDHD (Control) and (2) patients with a history of SDHD (SDHD group) prior to TSA. The SDHD and control groups were matched 1:1 for comorbidities and demographics prior to conducting multivariable analysis for 90-day medical complications and 2-year surgical complications. After matching, there were 8,023 patients in the SDHD group and 8,023 patients in the control group. The SDHD group had significantly higher odds for 90-day medical complications including heart failure, cerebrovascular accident, renal failure, deep vein thrombosis, pneumonia, sepsis, and urinary tract infection. Additionally, the SDHD group had significantly higher odds for revision surgery within 2-years following TSA. Patients in the SDHD group also had a significantly longer length of hospital stay following TSA. This study highlights the association between SDHD and postoperative complications following TSA. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHD is important in determining value-based payment models and risk stratifying to optimize patient care.

The impact of neighborhood social disadvantage on presentation and management of first-time hemodialysis access surgery patients

ObjectivesThe impact of social determinants of health on the presentation, management, and outcomes of patients requiring hemodialysis (HD) arteriovenous (AV) access creation have not been well-characterized. The Area Deprivation Index (ADI) is a validated measure of aggregate community-level social determinants of health disparities experienced by members living within a community. Our goal was to examine the effect of ADI on health outcomes for first-time AV access patients. MethodsWe identified patients who underwent first-time HD access surgery in the Vascular Quality Initiative between July 2011 to May 2022. Patient zip codes were correlated with an ADI quintile, defined as quintile 1 (Q1) to quintile 5 (Q5) from least to most disadvantaged. Patients without ADI were excluded. Preoperative, perioperative, and postoperative outcomes considering ADI were analyzed. ResultsThere were 43,292 patients analyzed. The average age was 63 years, 43% were female, 60% were of White race, 34% were of Black race, 10% were of Hispanic ethnicity, and 85% received autogenous AV access. Patient distribution by ADI quintile was as follows: Q1 (16%), Q2 (18%), Q3 (21%), Q4 (23%), and Q5 (22%). On multivariable analysis, the most disadvantaged quintile (Q5) was associated with lower rates of autogenous AV access creation (OR, 0.82; 95% confidence interval [CI], 0.74-0.90; P < .001), preoperative vein mapping (OR, 0.57; 95% CI, 0.45-0.71; P < .001), access maturation (OR, 0.82; 95% CI, 0.71-0.95; P = .007), and 1-year survival (OR, 0.81; 95% CI, 0.71-0.91; P = .001) compared with Q1. Q5 was associated with higher 1-year intervention rates than Q1 on univariable analysis, but not on multivariable analysis. ConclusionsThe patients undergoing AV access creation who were most socially disadvantaged (Q5) were more likely to experience lower rates of autogenous access creation, obtaining vein mapping, access maturation, and 1-year survival compared with the most socially advantaged (Q1). Improvement in preoperative planning and long-term follow-up may be an opportunity for advancing health equity in this population.

The Impact of Neighborhood Social Disadvantage on Presentation and Management of Hemodialysis Access Surgery Patients

The impact of social determinants of health on the presentation, management, and outcomes of patients requiring hemodialysis (HD) access surgery have not been well characterized. The Area Deprivation Index (ADI) is a validated measure of aggregate community-level social determinants of health disparities experienced by members within a community. Herein, we examined the effect of ADI on health outcomes for first-time HD access patients. We identified patients who underwent first-time HD access surgery in the Vascular Quality Initiative between August 2011 and May 2022. Patient zip codes were correlated with an ADI quintile (Q1-Q5, least to most disadvantaged). Patients without ADI were excluded. Perioperative and long-term outcomes considering ADI were analyzed. There were 43,292 patients analyzed. The average age was 63 years, 43% were female, 60% were of White race, 10% were of Hispanic ethnicity, and 85% received autogenous arteriovenous (AV) access. Patient distribution by ADI quintile (Q) was as follows: Q1 (16%), Q2 (18%), Q3 (21%), Q4 (23%), and Q5 (22%). On multivariable analysis, the most disadvantaged quintile (Q5) was associated with decreased autogenous access creations (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.77-0.94; P = .002), fewer preoperative vein imaging (OR, 0.62; 95% CI, 0.50-0.77; P < .001), lower access maturation (OR, 0.82; 95% CI, 0.71-0.94; P = .005), and lower 1-year survival (OR, 0.80; 95% CI, 0.71-0.90; P < .001) compared to Q1. Q5 was not associated with significantly higher 1-year intervention rates (Table). The most socially disadvantaged (Q5) AV access creation patients were more likely to experience disparities at the time of preoperative AV access creation, access type, as well as well as at 1-year outcomes. Improvement in preoperative planning and long-term follow-up may be an opportunity for advancing health equity in this population.TableUnivariate and multivariable analysis of outcomes of interest stratified by Area Deprivation Index (ADI) quintileADIAV fistulaVein imaging obtainedAccess matured at last follow-up1-Year intervention1-Year survivalUniMultiUniMultiUniMultiUniMultiUniMultiQ16138 (87)(ref)2413 (91)(ref)2695 (86)(ref)798 (31)(ref)6483 (92)(ref)Q26771 (85)0.84 [0.75-0.93]2254 (91)1.01 [0.80-1.26]2840 (83)0.83 [0.72-0.97]961 (32)0.98 [0.86-1.11]7121 (89)0.82 [0.72-0.93]Q37717 (85)0.81 [0.73-0.89]2575 (94)1.50 [1.18-1.90]3253 (83)0.82 [0.71-0.95]1089 (31)0.93 [0.82-1.05]8122 (89)0.80 [0.71-0.90]Q48211 (84)0.76 [0.69-0.84]2619 (91)0.96 [0.78-1.19]3529 (84)0.91 [0.78-1.05]1268 (32)0.94 [0.83-1.06]8844 (90)0.88 [0.79-0.99]Q57838 (84)0.85- [0.77-0.94]2018 (88)0.62 [0.50-0.77]3694 (82)0.82 [0.71-0.94]1433 (34)0.99 [0.88-1.12]8370 (90)0.80 [0.71-0.90]P value<.001-<.001-<.001-.047-<.001-Multi, multivariable analysis; Uni, univariate analysis.Univariate results represented as number (%). Multivariable results represented as adjusted odds ratio. Brackets in multivariable analysis indicated the 95% confidence interval. Bold indicated statistically significant results. Of patients with long-term follow-up data, the average length of last long-term follow-up data was 383 ± 240 days. Open table in a new tab

Automatic extraction of social determinants of health from medical notes of chronic lower back pain patients.

We applied natural language processing and inference methods to extract social determinants of health (SDoH) information from clinical notes of patients with chronic low back pain (cLBP) to enhance future analyses of the associations between SDoH disparities and cLBP outcomes. Clinical notes for patients with cLBP were annotated for 7 SDoH domains, as well as depression, anxiety, and pain scores, resulting in 626 notes with at least one annotated entity for 364 patients. We used a 2-tier taxonomy with these 10 first-level classes (domains) and 52 second-level classes. We developed and validated named entity recognition (NER) systems based on both rule-based and machine learning approaches and validated an entailment model. Annotators achieved a high interrater agreement (Cohen's kappa of 95.3% at document level). A rule-based system (cTAKES), RoBERTa NER, and a hybrid model (combining rules and logistic regression) achieved performance of F1 = 47.1%, 84.4%, and 80.3%, respectively, for first-level classes. While the hybrid model had a lower F1 performance, it matched or outperformed RoBERTa NER model in terms of recall and had lower computational requirements. Applying an untuned RoBERTa entailment model, we detected many challenging wordings missed by NER systems. Still, the entailment model may be sensitive to hypothesis wording. This study developed a corpus of annotated clinical notes covering a broad spectrum of SDoH classes. This corpus provides a basis for training machine learning models and serves as a benchmark for predictive models for NER for SDoH and knowledge extraction from clinical texts.

Contextual modifiers of healthspan, lifespan, and epigenome in mice under chronic social stress

Sustained life stress and low socioeconomic status are among the major causes of aging-related diseases and decreased life expectancy. Experimental rodent models can help to identify the underlying mechanisms, yet very few studies address the long-term consequences of social stress on aging. We conducted a randomized study involving more than 300 male mice of commonly used laboratory strains (C57BL/6J, CD1, and Sv129Ev) chosen for the spontaneous aggression gradient and stress-vulnerability. Mice were exposed to a lifelong chronic psychosocial stress protocol to model social gradients in aging and disease vulnerability. Low social rank, inferred based on a discretized aggression index, was found to negatively impact lifespan in our study population. However, social rank interacted with genetic background in that low-ranking C57BL/6J, high-ranking Sv129Ev, and middle-ranking CD1 mice had lower survival, respectively, implying a cost of maintaining a given social rank that varies across strains. Machine learning linear discriminant analysis identified baseline fat-free mass as the most important predictor of mouse genetic background and social rank in the present dataset. Finally, strain and social rank differences were significantly associated with epigenetic changes, most significantly in Sv129Ev mice and in high-ranking compared to lower ranking subjects. Overall, we identified genetic background and social rank as critical contextual modifiers of aging and lifespan in an ethologically relevant rodent model of social stress, thereby providing a preclinical experimental paradigm to study the impact of social determinants of health disparities and accelerated aging.

159 Bearing a higher burden: Black and Latinx community perspectives on the Impact of COVID-19

OBJECTIVES/GOALS: During earlier periods of the pandemic, Black and Latinx populations in Michigan have suffered higher rates of infection, hospitalization, and deaths when compared to Whites. We conducted this study to understand how Black and Latinx residents perceived this disproportionate burden. METHODS/STUDY POPULATION: In 2021, 40 semi-structured interviews were conducted virtually in English or Spanish with Black (n=24) and Latinx (n=16) residents in Michigan areas highly impacted by COVID-19: Genesee, Kent, Washtenaw, and Wayne counties. Using a Community-Based Participatory Research (CBPR) approach, we partnered with leaders from 15 community-based organizations and health and human service agencies to develop research questions, an interview protocol, and to interpret the data. We used the data analysis software Dedoose (ver 4.12) for inductive coding (IRR=0.81). This study is a part of the NIH Community Engagement Alliance (CEAL) Against COVID-19 initiative. RESULTS/ANTICIPATED RESULTS: Participants described the significant impact of the pandemic in terms of physical and mental health, job security, and the sheer number of deaths among loved ones. They attributed the impact to comorbidities and social determinants of health disparities exacerbated by the pandemic, including income, housing, access to healthcare, as well as systemic racism. They noted being overrepresented among frontline workers with higher exposure to COVID-19, limited or misinformation about the virus, language barriers, and difficulty with social distancing. Cultural norms that promote being in close proximity, such as intergenerational households, and loss of trusted community leaders were also noted. DISCUSSION/SIGNIFICANCE: Findings reflect the needs of Black and Latinx community members in Michigan and the discussions they feel are important to highlight. We must work strategically with partners and the community to provide transparency and effective leadership, and prioritize addressing systemic disparities in SDoH.

Impact of Social Isolation and Digital Divide on Mental Health and Wellbeing in Patients with Mental Health Disorders during COVID-19: A Multiple Case Study

The positive relationship between social connections and mental health and wellbeing has been widely documented. During the initial stage of the pandemic, COVID-19 associated restrictions had given rise to social isolation that had a negative effect on individuals’ mental health and wellbeing, particularly among patients with preexisting mental health disorders. To abridge physical distance, digital technology had become a primary method of communication and social engagement. However, not everyone had access to internet and devices required to connect online due to the digital divide, especially among marginalized populations. The purpose of this multiple case study was to explore experiences of social isolation and the digital divide among patients with mental health disorders, and its impact on their mental health and wellbeing. Our findings revealed that social isolation was the major contributing factor to the intensification of mental health symptoms, while the digital divide (e.g., financial constraints and low proficiency in digital technology) was recognized as a barrier to making social connections via digital technologies. Nurses should engage with communities and policymakers in developing strategies to address the social determinants of health disparities during the current pandemic, other disruptive pandemics and beyond.

Preinjury Social Determinants of Health Disparities Predict Postinjury Psychosocial Conditions in Adult Traumatic Brachial Plexus Injuries.

Adult traumatic brachial plexus injuries (TBPIs) are life-altering events that can have detrimental effects on a patient's quality of life. To examine how social determinants of health (SDOH) disparities influence the risk of developing new psychosocial conditions after TBPIs in previously psychiatric-naïve patients. Between January 2010 and June 2019, a retrospective analysis was performed using PearlDiver's Mariner, an all-payer claims database, to create 3 cohorts: TBPI disparity cohort: patients with TBPI and presence of at least 1 SDOH disparity before injury, TBPI without disparity cohort: patients with TBPI and the absence of any SDOH disparity, and control cohort: patients without TBPIs. The matched population analyzed in this study consisted of 1176 patients who were equally represented in the TBPI disparity cohort (n = 392, 33.33%), TBPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with 4 years of their injury. Patients in the TBPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, P < .0005), depression (22.70%, P = .0032), anxiety (18.62%, P = .0203), drug abuse (7.91%, P = .0060), and alcohol abuse (4.85%, P = .03499) when compared with the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (hazard ratio 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups. TBPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Level of Evidence: Prognostic Level III.

Social Determinants of Health Disparities Are Associated With Increased Costs, Revisions, and Infection in Patients Undergoing Arthroscopic Rotator Cuff Repair

<h3>Purpose</h3> The purpose of this study was to use a national claims database to assess the impact of pre-existing social determinants of health disparities (SDHD) on postoperative outcomes following rotator cuff repair (RCR). <h3>Methods</h3> A retrospective review of the Mariner Claims Database was used to capture patients undergoing primary RCR with at least 1 year of follow-up. These patients were divided into two cohorts based on the presence of a current or previous history of SDHD, encompassing educational, environmental, social, or economic disparities. Records were queried for 90-day postoperative complications, consisting of minor and major medical complications, emergency department (ED) visits, readmission, stiffness, and 1-year ipsilateral revision surgery. Multivariate logistic regression was employed to assess the impact of SDHD on the assessed postoperative outcomes following RCR. <h3>Results</h3> 58,748 patients undergoing primary RCR with a SDHD diagnosis and 58,748 patients in the matched control group were included. A previous diagnosis of SDHD was associated with an increased risk of ED visits (OR 1.22, 95% CI 1.18-1.27; <i>P</i> < .001), postoperative stiffness (OR 2.53, 95% CI 2.42-2.64; <i>P</i> < .001), and revision surgery (OR 2.35, 95% CI 2.13-2.59; <i>P</i> < .001) compared to the matched control group. Subgroup analysis revealed educational disparities had the greatest risk for 1-year revision (OR 3.13, 95% CI 2.53-4.05; <i>P</i> < .001). <h3>Conclusions</h3> The presence of a SDHD was associated with an increased risk of revision surgery, postoperative stiffness, emergency room visits, medical complications, and surgical costs following arthroscopic RCR. Overall, economic and educational SDHD were associated with the greatest risk of 1-year revision surgery. <h3>Level of Evidence</h3> III, retrospective cohort study.

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

To assess the individual impact of social determinants of health disparities (SDHD) on surgical outcomes following orthopaedic trauma surgery. Retrospective Cohort Study. Mariner Claims Database. Inclusion criteria were patients 18-85 years of age, undergoing surgery for hip fractures or ankle fractures from 2010 to 2018. Patients were divided based on SDHD using International Classification of Diseases 9 and International Classification of Diseases 10 codes. Those with SDHD were propensity-score matched with those who did not have any disparities with respect to age, gender, Charlson comorbidity index, tobacco use, and obesity (body mass index >30 kg/m2). Ninety-day major medical complications, infection, readmission, and revisions within 1 year. Patients with educational deficiencies had increased rates of readmission and major complications compared with those without disparities following hip and ankle fracture management. Moreover, economic disparities were associated with an increased risk of readmission and revision following hip fracture surgery and infection and readmission following ankle fracture surgery. This study emphasizes the large impact of SDHD on patients' outcomes following surgery and the importance of proper follow-up interventions to optimize patient care. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Abstract 240: Leveraging Health Equity Data To Drive Public Health And Health Care Practice, 2010-2020

Objectives: Increasing the understanding of the variety of data sources around health equity that are available and how to use these data to drive public health and health care practice is critical to address inequities and improve health outcomes. The social determinants of health (SDOH), factors related to where people live, work, play, and age, are strongly tied to health outcomes. Primary and secondary SDOH can be used to understand the context of the issues faced at the individual and community levels and can help inform appropriate interventions and support the connection to available resources. Methods: The Heath Equity Profile, available from the public facing Florida Community Health Assessment Resource Toolset (FLHealthCHARTS) website, contains over 150 indicators at the county-level related to demographics, income and employment, housing, education, risk behaviors, access to care, access to food, and various health outcomes, including prevalence, incidence, morbidity, and mortality. The indicators contained in the Health Equity Profile were used to identify counties with the largest SDOH disparities and largest burden of poor health outcomes for several initiatives focused on increasing community-clinical linkages and leveraging cross-sector partnerships to address health outcomes. Findings: Public health initiatives focused on hypertension, diabetes, and heart disease have leveraged the data contained in the Health Equity Profile to select geographic areas for implementation. Using these data, interventions were able to be deployed in areas with the greatest need and opportunity to benefit. Understanding the conditions under which individuals live is critical to the successful implementation of both public health and health care improvement efforts. Various data sources are widely available that can provide additional context and guidance for the development of tailored interventions to improve individual and population health.

140 Social Determinants of Health: A Critical Factor in Adult Traumatic Brachial Plexus Injury Outcomes

INTRODUCTION: Over the past three decades, there has been an accumulation of evidence pointing to social determinants of health (SDOH) as inherent causes for an array of health outcomes. METHODS: Between January 2010—June 2019, a retrospective analysis was performed using PearlDiver’s Mariner. One-to-one exact-matching based on baseline patient demographics was completed, creating three identical groups: AT-BPI disparity cohort: patients with AT-BPI and presence of at least one SDOH disparity prior to injury: • economic instability • food insecurity • inadequate education • community and social context problems • inaccessible healthcare facilities • neighborhood and physical environment issues AT-BPI without disparity cohort: patients with AT-BPI and the absence of any SDOH disparity. Control cohort: patients without AT-BPIs. The following primary psychosocial outcomes were included in our study: depression, anxiety, drug abuse, alcohol abuse, suicide attempt, post-traumatic stress disorder, and divorce. RESULTS: The matched population analyzed in this study consisted of 1,176 patients that were equally represented in the AT-BPI disparity cohort (n = 392, 33.33%), AT-BPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with four-years of their injury. Patients in the AT-BPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, p &lt; 0.0005), depression (22.70%, p = 0.0032), anxiety (18.62%, p = 0.0203), drug abuse (7.91%, p = 0.0060), and alcohol abuse (4.85%, p = 0.03499) when compared to the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (HR 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups. CONCLUSION: AT-BPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Clinicians should routinely screen for psychiatric conditions and assess social factors to improve identification of at-risk patients. A multidisciplinary approach incorporating medical, surgical, social, and psychological experts should be considered when managing these injuries.

Racial and Social Determinants of Health Disparities in Spine Surgery Affect Preoperative Morbidity and Postoperative Patient Reported Outcomes: Retrospective Observational Study.

Retrospective observational study. To elucidate racial and socioeconomic factors driving preoperative disparities in spine surgery patients. There are racial and socioeconomic disparities in preoperative health among spine surgery patients, which may influence outcomes for minority and low socioeconomic status (SES) populations. Presenting, postoperative day 90 (POD90), and 12-month (12M) outcome scores (PROMIS global physical and mental [GPH, GMH] and visual analog scale pain [VAS]) were collected for patients undergoing deformity arthrodesis or cervical, thoracic, or lumbar laminotomy or decompression/fusion; these procedures were the most common in our cohort. Social determinants of health for a patient's neighborhood (county, zip code, or census tract) were extracted from public databases. Multivariable linear regression with stepwise selection was used to quantify the association between a patient's preoperative GPH score and sociodemographic variables. Black patients presented with 1 to 3 point higher VAS pain scores (7-8 vs. 5-6) and lower (worse) GPH scores (6.5-10 vs. 11-12) than White patients (P < 0.05 for all comparisons); similarly, lower SES patients presented with 1.5 points greater pain (P < 0.0001) and 3.5 points lower GPH (P < 0.0001) than high SES patients. Patients with lowest-quartile presenting GPH scores reported 36.8% and 37.5% lower (worse) POD-90 GMH and GPH scores than the highest quartile, respectively (GMH: 12 vs. 19, P < 0.0001; GPH: 15 vs. 24, P < 0.0001); this trend extended to 12 months (GMH: 19.5 vs. 29.5, P < 0.0001; GPH: 22 vs. 30, P < 0.0001). Reduced access to primary care (B = -1.616, P < 0.0001) and low SES (B = -1.504, P = 0.001), proxied by median household value, were independent predictors of worse presenting GPH scores. Racial and socioeconomic disparities in patients' preoperative physical and mental health at presentation for spine surgery are associated adversely with postoperative outcomes. Renewed focus on structural factors influencing preoperative presentation, including timeliness of care, is essential.Level of Evidence: 3.

Social Determinants of Alzheimer’s Disease and Related Dementias: Racial and Regional Variations

To examine whether racial and regional social determinants of health disparities exist for older adults with Alzheimer’s disease and related dementias (ADRD). We identified 115,879 African American (AA) and White older adults with ADRD (10% from the Deep South) from administrative claims data for a 5% random sample of Medicare beneficiaries (2013-2015). We examined racial and regional differences across sociodemographic characteristics, county-level linked poverty indicators, medical resource availability categories, insurances quality indicators. Social context differences were found between regions including Deep South older adults with ADRD having higher economic impoverishment and lower access rates to specialty medical care services. Older Deep South AA had higher Medicare/Medicaid eligibility rates and less medical access. Significant socioeconomic disparities exist between Deep South and other US regions across several social determinant factors in older adults with ADRD. Social context differences were especially prominent for older Deep South AA with ADRD.