Impact Of Social Determinants Of Health Research Articles

Role of social determinants burden on outcomes and survival for AYAs with cancer.

1610 Background: Health care utilization and survival are correlated with social determinants of health (SDoH). Minimal data exists on the impact of SDoH within AYA Oncology. Methods: TriNetX, a de-identified healthcare research database retrospectively examined presence of SDoH billing codes among AYA cancer patients at various time points. Three cohorts were evaluated: ages <15, 15-39, >39. Cox proportional hazards regression was used to assess predictors of SDoH burden and survival in AYAs. Results: Baseline demographics were similar across cohorts. AYAs had higher baseline SDoH (25811, 5.2%) compared to <15 (3913, 2.9%) and >39 (58237, 1.8%). After diagnosis, AYAs had greater incidence of SDoH burden at 1y (OR 1.86 vs <15, 2.71 vs >39), 3y (OR 1.79 vs <15, 2.63 vs >39), and 5y (OR 1.8 vs <15, 2.5 vs >39). AYAs with any SDoH had higher occurrences of ED (OR 2.51) and ICU visits (OR 1.94). Within AYAs, baseline SDoH code was most prevalent in 30-39 age group, males, Hawaiian/Pacific Islanders, and lung cancers. The most common SDoH code in AYAs at diagnosis was homelessness at 57.8%. In a multivariate analysis examining incidence of SDoH in AYAs, positive associations were age 30-39; 1.95 (1.61-2.37), males; 1.49 (1.36-1.63), American Indian/Alaska Native; 4.44 (3.12-6.31), and presence of SDoH at diagnosis; 83.0 (71.6-96.3). Mortality in AYAs was associated with age 30-39; 1.81 (1.72-1.91), males; 1.58 (1.54-1.63), unknown race; 1.53 (1.48-1.58), and CNS tumors; 1.15 (1.06-1.25). Conclusions: AYAs with cancer have a high prevalence of SDoH burden at diagnosis and acquired. Within AYAs, age 30-39, males, and minority populations were most likely to acquire a SDoH code and have worse survival. The strongest association with both incidence of SDoH burden and mortality was a SDoH code at diagnosis. [Table: see text]

Social determinants of health and long-term conditions in people of Black African and Black Caribbean ethnicity living with HIV in London: Aqualitative study.

People living with human immunodeficiency virus (HIV) are disproportionately impacted by socioeconomic deprivation and are at increased risk of developing other long-term conditions (LTCs). These illnesses require transformative action to tackle the adverse effects on their health. Data on lived experiences of LTCs among people living with HIV of Black African and Black Caribbean ethnicities are sparse, and how people with LTCs are impacted by social determinants of health (SDoH). Through a phenomenological study design this qualitative study, conducted in 2022, comprised four focus group discussions (FGDs) with 20 people of Black ethnicities living with HIV were purposively invited from a community organisation (CO) in London, including four semistructured interviews with CO staff. Following transcription, qualitative data were analysed thematically and measures to validate the findings were implemented. The findings are presented in terms of the following four levels of SDoH: (1) individual determinants (such as the impact of SDoH on lifestyle modification and self-management); (2) interpersonal determinants (such as positive experiences of accessing healthcare for LTCs); (3) clinical determinants (such as care pathway barriers)and (4) systemic determinants (such as systemic barriers related to race/ethnicity). It is necessary to provide ongoing and interactive education to community members who live with HIV, focusing on risks and management of LTCs. Additionally, individuals would benefit from support to navigate increasingly complex and fragmented health services. Health Service staff require cultural competence when caring for patients of Black African and Black Caribbean ethnicities with complex health and psychosocial needs. The research team collaborated with an HIVCOin South London from the very start of the project to agree the study design and learn about the realities of their daily lived experiences. Community collaborators helped to develop the semistructured interview and FGDtopic guides, and were directly involved in the data gathering, analysis and validation.

Abstract TP103: Association Between Neighborhood-Level Disadvantage and Patient-Reported Mental Health Outcomes in Intracerebral Hemorrhage Survivors

Introduction: The influence of social determinants of health (SDH) is well-documented across a range of medical conditions and health outcomes. Less clear is the impact of SDH on patient-reported outcomes, particularly mental health outcomes, in intracerebral hemorrhage (ICH). This study examines the association between the Area Deprivation Index (ADI), a measure of neighborhood-level disadvantage, and self-reported health outcomes in ICH survivors. Methods: This investigation is nested within the REDUCE clinical trial, an ongoing, randomized trial comparing standard-of-care to spironolactone-containing hypertension regimens in ICH survivors. Participants complete the PROMIS Global Health survey at baseline. Global Mental Health (GMH) and Global Physical Health (GPH) scores are standardized to t-scores (GMH 21.2-67.6; GPH 16.2-67.7) around a reference population mean (50 ± 10). ADI uses elements of income, education, employment, and housing quality to assign a composite score (1-100), with a higher score signifying greater disadvantage. Patients were grouped into tertiles based on ADI. GMH and GPH scores were analyzed against the reference mean via a one-sample t-test and across tertiles with a one-way ANOVA. Bivariable linear regression examined ADI as a continuous variable. Multivariable models adjusted for sex, age, race, ethnicity, ICH to baseline interval, and baseline mRS. Results: Fifty patients were included in the analysis. Those in the third, most disadvantaged, tertile had significantly lower GMH scores (39.5 ± 8.17) than the reference population (p<0.001), the first tertile (54.10 ± 10.20, p<0.001), and the second tertile (50.4 ± 8.90, p=0.003). In multivariable analysis, these differences remained significant (T3 vs. T1, B= -18.31, p<0.001; T3 vs. T2, B= -14.67, p<0.001). Further, ADI as a continuous variable was significantly associated with GMH scores in bivariable (B= -0.22, p<0.001) and multivariable analysis (B= -0.23, p=0.005). No significant relationship was found between ADI and GPH. Conclusions: Higher ADI is associated with worse patient-reported mental health outcomes after ICH. Neighborhood disadvantage, and its constituting factors, should be considered in reporting post-ICH patient care and outcomes.

Social Determinants of Health Impact Spinal Cord Injury Outcomes in Low- and Middle-Income Countries: A Meta-Epidemiological Study.

Traumatic spinal cord injuries (SCI), which disproportionally occur in low- and middle-income countries (LMICs), pose a significant global health challenge. Despite the prevalence and severity of SCI in these settings, access to appropriate surgical care and barriers to treatment remain poorly understood on a global scale, with data from LMICs being particularly scarce and underreported. This study sought to examine the impact of social determinants of health (SDoH) on the pooled in-hospital and follow-up mortality, and neurological outcomes, after SCI in LMICs. A systematic review was conducted in adherence to the Preferred Reporting in Systematic Review and Meta-Analysis-guidelines. Multivariable analysis was performed by multivariable linear regression, investigating the impact of the parameters of interest (patient demographics, country SDoH characteristics) on major patient outcomes (in-hospital/follow-up mortality, neurological dysfunction). Forty-five (N = 45) studies were included for analysis, representing 13 individual countries and 18 134 total patients. The aggregate pooled in-hospital mortality rate was 6.46% and 17.29% at follow-up. The in-hospital severe neurological dysfunction rate was 97.64% and 57.36% at follow-up. Patients with rural injury had a nearly 4 times greater rate of severe in-hospital neurological deficits than patients in urban areas. The Gini index, reflective of income inequality, was associated with a 23.8% increase in in-hospital mortality, a 20.1% decrease in neurological dysfunction at follow-up, and a 12.9% increase in mortality at follow-up. This study demonstrates the prevalence of injury and impact of SDoH on major patient outcomes after SCI in LMICs. Future initiatives may use these findings to design global solutions for more equitable care of patients with SCI.

The impact of social determinants of health on textbook oncological outcomes and overall survival in locally advanced non–small cell lung cancer

ObjectivesTextbook oncological outcome (TOO) is a composite metric for surgical outcomes, including non–small cell lung cancer (NSCLC). We hypothesized that social determinants of health (SDH) can affect both the attainment of TOO and the overall survival (OS) in surgically resected NSCLC patients with pathological nodal disease. MethodsWe queried the National Cancer Database (2010-2017) for preoperative therapy-naïve lobectomies for NSCLC with tumor size <7 cm and pathologic N1/N2. Socioeconomic factors comprised SDH scores, where SDH negative (−) was considered if SDH ≥2 (disadvantage); otherwise, SDH was positive (+). TOO+ was defined as R0 resection, ≥5 lymph nodes resected, hospital stay <75th percentile, no 30-day mortality, adjuvant chemotherapy initiation ≤3 months, and no unplanned readmission. If one of these parameters was not achieved, the case was considered TOO–. ResultsOf 11,274 patients, 48% of cases were TOO+ and 38% were SDH+. A total of 15% of patients were SDH– and were less likely (adjusted odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92) to achieve TOO+ than patients with SDH+. After accounting for confounders, patients with TOO+ had 22% lower overall mortality than patients with TOO– (adjusted hazard ratio, 0.78; CI, 0.73-0.82). In contrast, SDH– remained an independently significant risk factor, reducing survival by 24% compared with SDH+ (adjusted hazard ratio, 1.24; CI, 1.17-1.32). The impact of SDH on OS was significant for both patients with TOO+ and TOO–: SDH+/TOO+ had the best OS and SDH–/TOO–had the worst OS. ConclusionsSDH score has a significant association with TOO achievement and TOO-driven overall posttreatment survival in patients with lobectomy-resected NSCLC with postoperative pathologic N1/N2 nodal metastasis. Addressing SDH is important to optimize care and long-term survival of this patient population.

POSTER: CML-062 Define the Vulnerable - Social Determinants of Health Impact on Hematological Malignancies Affecting Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis

POSTER: CML-062 Define the Vulnerable - Social Determinants of Health Impact on Hematological Malignancies Affecting Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis

CML-062 Define the Vulnerable - Social Determinants of Health Impact on Hematological Malignancies Affecting Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis

CML-062 Define the Vulnerable - Social Determinants of Health Impact on Hematological Malignancies Affecting Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis

Emergency department use and geospatial variation in social determinants of health: a pilot study from South Carolina

BackgroundHealth systems are increasingly addressing patients’ social determinants of health (SDoH)-related needs and investigating their effects on health resource use. SDoH needs vary geographically; however, little is known about how this geographic variation in SDoH needs impacts the relationship between SDoH needs and health resource use.MethodsThis study uses data from a SDoH survey administered to a pilot patient population in a single health system and the electronic medical records of the surveyed patients to determine if the impact of SDoH needs on emergency department use varies geospatially at the US Census block group level. A Bayesian zero-inflated negative binomial model was used to determine if emergency department visits after SDoH screening varied across block groups. Additionally, the relationships between the number of emergency department visits and the response to each SDoH screening question was assessed using Bayesian negative binomial hurdle models with spatially varying coefficients following a conditional autoregressive (CAR) model at the census block group level.ResultsStatistically important differences in emergency department visits after screening were found between block groups. Statistically important spatial variation was found in the association between patient responses to the questions concerning unhealthy home environments (e.g. mold, bugs/rodents, not enough air conditioning/heat) or domestic violence/abuse and the mean number of emergency department visits after the screen.ConclusionsNotable spatial variation was found in the relationships between screening positive for unhealthy home environments or domestic violence/abuse and emergency department use. Despite the limitation of a relatively small sample size, sensitivity analyses suggest spatially varying relationships between other SDoH-related needs and emergency department use.

Social Determinants of Health Impact on Survival of Patients With Malignant Pleural Mesothelioma

BackgroundPatients with malignant pleural mesothelioma (MPM) have a high mortality risk, even after optimal management and accounting for differences in comorbidities. We aimed to assess the overall survival of patients with operable MPM based on social determinants of health (SDH). We hypothesized that an SDH score can predict patients with poorer overall survival despite optimal management. MethodsThis study used a retrospective analysis of the National Cancer Database from 2004 to 2017. Adult patients with clinical stage I-IIIA MPM were included. Based on patients’ personal and geographic characteristics, we constructed an SDH score index that identifies patients of socioeconomic disadvantage by the following variables: income, education, geography, and hospital types within 250 miles. We performed a survival analysis using the Kaplan-Meier method as well as univariable and multivariable Cox regression models. ResultsHigher composite SDH scores demonstrated worse outcomes. Overall increased disadvantage increased the risk of mortality by 21% (hazard ratio [HR], 1.21; CI, 1.12-1.30), with a higher increase of 57% for score ≥2 (HR,1.57; CI, 1.36-1.81). After accounting for age, stage, comorbidities, multimodal therapy, and hospital volume and type, the SDH score index remained statistically significant, with a 29% increased risk of mortality for score ≥2 compared with ≤1 (HR, 1.29; CI, 1.10-1.50). Curative surgery with chemotherapy reduced mortality risk by 29% (HR, 0.71; CI, 0.62-0.81) after adjustment for patients' SDH scores and other relevant factors. ConclusionsVarious SDH factors affect survival outcomes independently of treatment modality and patient characteristics. This SDH composite score could help identify patients with socioeconomic disadvantages at risk for suboptimal survival outcomes.

Athletic Trainers' Perceptions of and Experience with Social Determinants of Health.

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.

Abstract 4371: iCCaRe: Social determinants of health navigation, psycho-oncology, and emotional support for Black prostate cancer survivors: Review of current practices

Abstract Background: Black men continue to be disproportionately affected by prostate cancer incidence and mortality as compared to their White counterparts, despite worldwide declining prostate cancer diagnosis rates. This complex phenomenon remains poorly understood, especially at the point of a prostate cancer diagnosis. Newly diagnosed Black men report initial feelings ranging from being “shocked,” to “receiving a death sentence,” and both an ineptness of asking questions and a reliance on physicians for treatment options due to lack of knowledge. The psychological distress from prostate cancer uncertainties affects health management and treatment decisions, though it is unclear to what extent the role of social determinants of health factor in making informed healthcare decisions. Aim: In this scoping review, we examined the influence of the social determinants of health at point of prostate cancer diagnosis among Black men seeking to make an informed decision about their treatment plans. Methods: We followed the methodological framework: the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic databases, Emabase, Pubmed, PsycInfo, Scopus, and Web of Science were searched for quantitative and qualitative primary studies from the period 2005 until March 2022. Two authors independently screened titles and abstracts, and full texts, against predefined criteria: empirical research, post 2000, in English-language peer-reviewed journals; participants included Black prostate cancer survivors and research explored social determinants of health at point of prostate cancer diagnosis. Studies were quality assessed for data charting. Results: The search yielded 283 studies, with 45 included studies for synthesis. Traditional social determinants of health were frequent. However, identification of themes such as social support, masculinity and stigma, fear of abandonment by medical staff, and cost of diagnostic procedures were prominent determinants. Notably, sub-themes emerged that included coping factors such as emotional distress, perceptions of normalcy, and poor prostate cancer knowledge. Conclusion: Understanding the social determinants of health impact on Black men, especially at point of prostate cancer diagnosis will allow survivors, physicians, and researchers to work at solving these health disparities. Citation Format: Dottington Fullwood, AJ Merriweather, Che Ngufor, Deidre Pereira, KC Balaji, Roxana Dronca, Gerardo Colon-Otero, Jennifer Crook, Parisa Fathi, Emelina Asto-Flores, Shannon Pressey, Folakemi Odedina. iCCaRe: Social determinants of health navigation, psycho-oncology, and emotional support for Black prostate cancer survivors: Review of current practices. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4371.

The Impact of the Social Determinants of Human Health on Companion Animal Welfare

The social determinants of health (SDH) focus on the social, physical and economic factors that impact human health. Studies have revealed that animal guardians face a range of challenges in attaining positive welfare outcomes for their companion animals, which can be influenced by socioeconomic and environmental factors. Despite this, there is a lack of research specifically exploring the relationship between SDH and animal welfare outcomes. Given that the SDH impact on humans, which in turn directly impacts on their companion animal, it is important to adapt an SDH framework for companion animal welfare by characterising the impact of the SDH on companion animal guardians in their attempts to care for their animals and, by extension, the associated welfare outcomes. This paper explores how these human health determinants may impact animal welfare and the possible challenges that may arise for the guardian when attempting to meet their companion animal's welfare needs. By integrating the SDH with other key frameworks, including the five domains model of animal welfare, through multidisciplinary collaboration, this framework can be used to inform future programs aiming to improve animal welfare.

Oral health inequalities and disability: Closing the gap.

The social determinants of health impact disproportionately on disabled people creating a cumulative risk of unequal oral health outcomes, compounded by impairment. Problems in early life, education and employment, poor social status and support, social exclusion, poverty and stress characterize the life course of many disabled people. Ableism and exclusion combine to ensure that disabled voices are rarely heard, ignorance and indifference lead to prejudice in policy-making and enforcement and negative media attitudes fuelled by political austerity lead to stigmatization. Yet, the health disparities experienced by disabled people are still perceived as being uniquely caused by a medical condition or impaired body function, excluding disabled people from the inequalities discourse. In parallel, the influence of medical conditions within other marginalized groups are minimized (e.g. mental health), leading to the underestimation of the impact of disability on oral health generally. The common ground between all groups subject to oral health inequalities can be conceptualized using the WHO International Classification of Functioning. Outcomes for all might be improved by emphasizing this common ground; by considering disability as a primary variable, such as gender or age; by identifying disabled people within existing inequalities research; and by explicitly including disabled people in future research.

Maternal Health Outcomes in a Somalia Post-war Context: a PhD thesis analyzing trends towards universal health coverage

Abstract Somalia has one of the highest maternal mortality ratios in the world and an inequitable distribution of maternal health outcomes and service utilisation. Like other developing countries, Somalia has adopted the global policy goal of attaining universal health coverage of health services and improved health outcomes across all populations. Although United Nations agencies track the progress towards achieving universal health coverage as part of health targets for achieving the Sustainable Development Goals, empirical case studies are rarely documented, especially in developing countries and even more so in post-war contexts such as Somalia. Literature shows the overall progress towards globally agreed-upon targets for maternal health lagging in war-affected countries, with persistent socioeconomic gradients in health outcomes. However, little is known about the mechanisms through which the social determinants of health impact on the distribution of maternal health outcomes. The aim of this study is to examine the mechanisms through which social determinants contribute to inequities in maternal health outcomes in Somalia. Specifically, the study will analyse the policy context and progress towards achieving universal health coverage of maternal health services in Somalia; analyse trends in maternal health outcomes and inequities in Somalia; and examine the mechanisms through which social determinants contribute to inequities in maternal health outcomes. A mixed-methods case study design will be adopted, employing both qualitative and quantitative approaches to data collection and analysis. The findings of this PhD research will contribute to the evidence base on pathways for achieving universal health coverage of maternal health outcomes in post-war countries like Somalia. This will facilitate development of effective health care policies and those addressing the social determinants, which if implemented will improve maternal health outcomes in Somalia and mark progress towards achieving the goal of universal maternal health coverage.

S1 Sarcopenia Is Associated With Social Determinants of Health in Patients With Inflammatory Bowel Disease

Background: Sarcopenia is defined as the loss of skeletal muscle mass and is a modifiable condition that affects between 27% to 61% of patients with inflammatory bowel disease (IBD). Social determinants of health (SDOH) are increasingly being identified as contributors to disparities and health outcomes in IBD. However, the impact of SDOH on sarcopenia in IBD remains understudied. We aimed to perform a comprehensive evaluation of the presence of SODH in sarcopenia within an IBD patient population. Methods: Patients (≥18 years) seen at the IBD Center with a confirmed diagnosis of IBD without short bowel syndrome were invited to complete a SARC-F questionnaire to assess for sarcopenia. Sarcopenia on SARC-F was defined as a score ≥4. Patients completed an additional 11-item dichotomous SDOH questionnaire. Retrospective chart review was performed for demographic and disease characteristics for all patients that completed the questionnaires. Each item on the SODH questionnaire was considered a risk factor and compared between the sarcopenia and non-sarcopenia groups using univariable analysis. The false discovery rate was used in multiple hypothesis testing to correct for multiple comparisons (shown as the q-value). Results: Among 233 patients that completed the SARC-F questionnaire, 44 patients met criteria for sarcopenia with a score ≥4 on SARC-F. Patients with sarcopenia had an average age of 48 and were predominantly Caucasian (95%). Tobacco use (25% vs 3.7%, P < 0.001), history of bowel surgery (59% vs 33%, P < 0.001) and body mass index (30 vs 26, P < 0.001) were all associated with sarcopenia on SARC-F. Almost all patients (99%) identified at least 1 SDOH factor, with an average of 3.9 factors. The most common SDOH factors in patients with sarcopenia were limited meetings or interactions with support groups (88%) and religious groups (79%). On univariable analysis, difficulty paying for basic needs such as food, housing, transportation, and medications (51% vs 15%, P < 0.001) was associated with sarcopenia. Patients that identified themselves as a lot or very stressed (60% vs 33%, P < 0.001) or had limited interactions with friends/relatives (47% vs 27%, P = 0.013) were also more likely to have sarcopenia. After applying the false discovery rate, these factors remained significant based on q-value. Conclusion(s): Our study identifies a high burden of social barriers amongst IBD patients with sarcopenia and SDOH screening should be considered at the time of diagnosis. Difficulty with basic needs, stress and limited interactions with loved ones are prevalent SDOH associated with sarcopenia in IBD. Multi-disciplinary interventions with social workers and mental health specialists may help address these needs.

Impact of social determinants of health on anticoagulant use among patients with atrial fibrillation: Systemic review and meta-analysis.

Background:A growing body of literature now exists examining associations between social determinants of health (SDOH) and adverse outcomes in patients with atrial fibrillation; however, little is available on anticoagulant prescriptions and the impact of SDOH.Purpose:Evaluate the impact of SDOH on anticoagulant prescriptions in patients with atrial fibrillation.Data Sources:Medline and Embase databases up to January 2021.Study Selection:Noninterventional studies were included if they reported associations between at least 1 of 14 SDOH domains and anticoagulant prescription in patients with atrial fibrillation. Two investigators independently screened and collected data.Data Extraction:Two investigators independently screened and collected data.Data Synthesis:Meta-analyses using random-effect models evaluated associations between SDOH and receiving an anticoagulant prescription. We included 13 studies, 11 of which were included in meta-analyses that reported on the impact of 9 of the 14 SDOH included in the search. Pooled estimates indicate a 0.85 (95% confidence interval [CI]: 0.75, 0.97) lower odds of receiving anticoagulant prescriptions among Black compared to non-Black patients (reported in 6 studies); 0.42 (95% CI: 0.32, 0.55) lower odds of receiving anticoagulant prescriptions among patients with mental illness compared to those without mental illness (2 studies); and a 0.64 (95% CI: 0.42, 0.96) lower likelihood of receiving oral anticoagulant prescription among employed patients compared to unemployed patients (2 studies).Limitations:SDOH lack consistent definitions and measures within the electronic health record.Conclusion:The literature reports on only half of the SDOH domains we searched for, indicating that many SDOH are not routinely assessed. Second, social needs impact the decision to prescribe anticoagulants, confirming the need to screen for and address social needs in the clinical setting to support clinicians in providing guideline concordant care to their patients.Registration:This systematic review and meta-analysis was registered with PROSPERO.

Defining the role of pharmacists in addressing the social determinants of health.

As one of the overreaching goals of Healthy People 2030, addressing the social determinants of health (SDOH) to reduce health disparities is a nationwide concern, with objectives informed by interdisciplinary teams of experts. However, there remains much discussion regarding the roles of healthcare providers in addressing SDOH. While current guidance suggests that all members of the healthcare team must be empowered to address SDOH, current guidance explicitly references physicians, nurses, social workers and staff, and do not specifically include pharmacists. While pharmacists are taught about the impact of SDOH in pharmacy curricula, actionable strategies for pharmacists to address SDOH in practice have not been clearly outlined. Pharmacists have multifaceted interactions with patients and may be influential in meeting individual patient needs, identifying social risk factors, and addressing upstream causes of health disparities. This paper proposes a framework for the role of pharmacists in addressing the SDOH through strategies at the patient, practice, and community levels. The concepts presented in this paper are meant to serve as a launch point for discussion and to promote the inclusion of pharmacists in the conversations around sustainable efforts to achieve health equity. This framework is not intended to limit the scope of pharmacists in addressing SDOH - on the contrary, it is our hope that this outline may be used to expand the education of future healthcare professionals regarding their role in addressing the social determinants of health.

Findings from the implementation of a novel needs assessment survey in children and youth with epilepsy; The impact of social determinants of health on utilization of medical services

ObjectiveThis study aimed to characterize the relationship between social determinants of health (SDOH) and epilepsy-specific outcomes. MethodsThis was an observational, cross-sectional, quality improvement study. We developed a novel screening survey (The Epilepsy Needs Assessment Survey), which was administered to patients with epilepsy at a large urban hospital. We assessed the prevalence of various SDOH and the association with independence in activities of daily living, verbal status, prevalence of intractable epilepsy, missed school/work days, missed neurology appointments and emergency department visits related to seizure. ResultsForty-nine percent of participants reported at least one insecurity. While disease burden did not appear to differ significantly between families with and without hardships, families who reported any hardship had almost twice the percentage of missed neurology appointments and were significantly more likely to have an ED visit related to seizure (RR = 5.44, CI 2.82–10.48). SignificanceSeveral studies have suggested that social determinants of health (SDOH) impact various patient health outcomes such as developmental concerns, functional limitations and higher healthcare utilization. The majority of studies have been performed in general pediatric clinics and the impact of SDOH on patients with complex medical conditions in subspecialty clinics has not been well documented. This is one of the first studies to assess the effects of SDOH on patient-centered, epilepsy specific outcomes using a low cost, novel standardized screening tool.

Providing Orthopaedic Care to Vulnerably Underserved Patients: AOA Critical Issues.

Implementation of the Affordable Care Act has increased the number of Americans with health insurance. However, a substantial portion of the population is still considered underserved, including those who are uninsured, underinsured, and those who are enrolled in Medicaid. The patients frequently face substantial access-to-care issues. Many underlying social determinants of health impact this vulnerable, underserved population, and surgeons must understand the nuances of caring for the underserved. There are numerous opportunities to engage with this population, and providing care to the indigent can be rewarding for both the vulnerably underserved patient and their surgeon.

Addressing cancer health disparities (CHD) in an independent community cancer clinic: All solutions are local.

e18522 Background: The COVID-19–associated global pandemic has brought many public and population health issues to light. A glaring issue is the disparities among and differences in susceptibility of diverse ethnicities. Viral infection is not the only area of healthcare facing this issue: disparities in prevalence, biology, prognosis, and outcomes of cancer exist, often based on socioeconomics and social determinants of health (SDoH). CHD have been debated and discussed at several levels, from local counties to the congress to the Centers for Medicare and Medicaid Services. Amid the debates and recommendations, it has been difficult to carve out a clear path forward. The complex factors involved include access to care because of financial challenges, biological and genetic factors, impact of SDoH, and access to screening, NGS testing, and clinical trials. CHD may contribute to almost 34% of deaths among adult cancer patients and additional spending of $230 billion. Addressing CHD could result in an indirect savings of as much as $1 trillion over 3 years (AACR, CDR, 2020). A comprehensive approach is needed to generate a groundswell of resources. This should include support for public policies aimed at improving understanding of the issue by all parts of the ecosystem (pharma, researchers, government agencies, physicians), adequate funding for federal and local initiatives, considerations of health in community planning and development, and collection of real-world data and evidence. At Carolina Blood and Cancer Care (CBCCA), the team decided to study this issue and initiate solutions one step at a time. Methods: CBCCA prioritized solutions in 5 categories. The top priority was to address issues impacting patients: access to care, NGS testing, cancer screening, SDoH, and clinical trial access. To address access to care issue (financial constraints), 2.5 FTEs (full-time equivalents) were allocated to carry out needs assessments and identify resources, including Medicaid eligibility, dual eligibility, other foundations, and sources for free drugs. A not-for-profit entity, No One Left Alone, was started to address CHD. Results: During 2021 CBCCA physicians saw 1787 unique cancer patients (both established and new). Of these, 319 needed IV anticancer treatment and an additional 104 needed oral oncolytics. Fifty-three could not pay for their cancer treatment. Another 101 patients needed assistance for out-of-pocket costs. Financial counselors procured free drugs worth $1,633,588 and an additional $135,931 in cash assistance for high out-of-pocket costs. The pharmacy team raised $253,218 for 64 patients (374 transactions) for out-of-pocket costs. As a result, not a single patient was left without treatment. Conclusions: Financial toxicity was addressed by allocating 0.5 FTE per oncologist to ensure access to care. In the next phase, CBCCA will address access to NGS testing.