Social Determinants Of Health Outcomes Research Articles

Barriers and enablers to improving integrated primary healthcare for non-communicable diseases and mental health conditions in Ethiopia: a mixed methods study

BackgroundThe Ethiopian Primary Healthcare Clinical Guidelines (EPHCG) seek to improve quality of primary health care, while also expanding access to care for people with Non-Communicable Diseases and Mental Health Conditions (NCDs/MHCs). The aim of this study was to identify barriers and enablers to implementation of the EPHCG with a particular focus on NCDs/MHCs.MethodsA mixed-methods convergent-parallel design was employed after EPHCG implementation in 18 health facilities in southern Ethiopia. Semi-structured interviews were conducted with 10 primary healthcare clinicians and one healthcare administrator. Organisational Readiness for Implementing Change (ORIC) questionnaire was self-completed by 124 health workers and analysed using Kruskal Wallis ranked test to investigate median score differences. Qualitative data were mapped to the Consolidated Framework for Implementation Science (CFIR) and the Theoretical Domains Framework (TDF). Expert Recommendations for Implementing Change (ERIC) were employed to select implementation strategies to address barriers.ResultsFour domains were identified: EPHCG training and implementation, awareness and meeting patient needs (demand side), resource constraints/barriers (supply side) and care pathway bottlenecks. The innovative facility-based training to implement EPHCG had a mixed response, especially in busy facilities where teams reported struggling to find protected time to meet. Key barriers to implementation of EPHCG were non-availability of resources (CFIR inner setting), such as laboratory reagents and medications that undermined efforts to follow guideline-based care, the way care was structured and lack of familiarity with providing care for people with NCDs-MHCs. Substantial barriers arose because of socio-economic problems that were interlinked with health but not addressable within the health system (CFIR outer setting). Other factors influencing effective implementation of EPHCG (TDF) included low population awareness about NCDs/MHCs and unaffordable diagnostic and treatment services (TDF). Implementation strategies were identified. ORIC findings indicated high scores of organisational readiness to implement the desired change with likely social desirability bias.ConclusionAlthough perceived as necessary, practical implementation of EPHCG was constrained by challenges across domains of internal/external determinants. This was especially marked in relation to expansion of care responsibilities to include NCDs/MHCs. Attention to social determinants of health outcomes, community engagement and awareness-raising are needed to maximize population impact.

Abstract 3554: Using All of Us cancer data on the Researcher Workbench to advance career development

Abstract This session will provide an overview of the All of Us Research Program (All of Us) dataset, discuss a mechanism to build the capacity of research institutions using the All of Us dataset, and outline the career benefits researchers experienced from using the dataset. All of Us is building a national health dataset to accelerate medical breakthroughs. It is used by cancer researchers to advance health research and career development. This dataset is large and diverse, both in the data types available as well as the demographics of participants: as of April 2023, health data from 413,450+ participants is available to researchers, from a variety of distinct data types, including survey responses, physical measurements, electronic health records, whole genome sequencing, wearable data, and genotyping arrays, with 75% of participants self-identifying as underrepresented in biomedical research and about 45% of participants self-identifying as racial and ethnic minorities. Researchers already leverage this dataset, with All of Us data used in more than 210 publications across peer-reviewed journals. In addition, this dataset is useful for cancer researchers - All of Us EHR data indicates over 60,700 participants are diagnosed with at least one type of cancer, and more than 10% of research projects underway (725/6,945 as of September 2023) using the All of Us dataset are cancer-related, making it the top condition studied by researchers. To help build capacity at research institutions, All of Us collaborated with the NCI Center to Reduce Cancer Health Disparities (CRCHD) Partnerships to Advance Cancer Health Equity (PACHE) to develop a Notice of Special Interest (NOSI) titled Administrative Supplements to Support "All of Us" and Health Disparities-Related Pilot Research Projects at NCI CRCHD-Funded PACHE Partnerships. The focus of this NOSI was on P20 and U54 awards associated with research projects led by PACHE researchers interested in exploring the connections between social determinants of health outcomes and populations experiencing cancer health disparities. NIH awarded investigators at the following institutions: City College of New York, University of California, Irvine, and Temple University. Principal investigators of these awards will provide an overview of their work, describe how they analyze the All of Us dataset, and discuss how their use of the dataset has helped advance their career as cancer researchers: Karen Hubbard (City College of New York) Project Title: Relative and Intersectional Analysis of social determinants of Lung Cancer Risk among Black and Hispanic All of Us respondents Hannah Lui Park (University of California, Irvine) Project Title: Improving breast cancer risk assessment and prevention in Asian American women Lin Zhu (Temple University) Project Title: Elucidating the Roles of Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease among Asian American Patients with Chronic Hepatitis B Citation Format: Karriem S. Watson, Rubin Baskir, Division of Engagement and OutreachAll of Us Research Program, Karen Hubbard, Hannah L. Park, Lin Zhu. Using All of Us cancer data on the Researcher Workbench to advance career development [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3554.

Recent Advances on Social Determinants of Mental Health: Looking Fast Forward.

The fields of psychiatry and mental health are increasingly recognizing the importance of social determinants of health (SDOH) and their impact on mental health outcomes. In this overview, the authors discuss the recent research, from the past 5 years, on advances made in SDOH work. SDOH frameworks and theories have expanded to include more social conditions, from traumas associated with immigration to psychosocial and community strengths, that impact mental health and well-being. Research has consistently shown the pervasive deleterious impacts of inequitable social conditions (e.g., food insecurity, housing instability) on minoritized populations' physical and mental health. Social systems of oppression (e.g., racism, minoritization) have also been shown to confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic illuminated the inequitable impact of the social determinants of health outcomes. More efforts have been made in recent years to intervene on the social determinants through interventions at the individual, community, and policy levels, which have shown promise in improving mental health outcomes in marginalized populations. However, major gaps remain. Attention should be paid to developing guiding frameworks that incorporate equity and antiracism when designing SDOH interventions and improving methodological approaches for evaluating these interventions. In addition, structural-level and policy-level SDOH efforts are critical for making long-lasting and impactful advances toward mental health equity.

Exploring the Social Determinants of Health Outcomes for Adults with Low Back Pain or Spinal Cord Injury and Persistent Pain: A Mixed Methods Study

Developing a greater understanding of the social and environmental factors that are related to differential outcomes for individuals who experience persistent pain and disability is important for achieving health equity. In this study, we aimed to develop insights into the role of the social determinants of health (SDH) in care experiences and health status for socio-economically disadvantaged adults who experience persistent low back pain or persistent pain following spinal cord injury. Our objectives were to investigate 1) relationships between the SDH and health outcomes, 2) care experiences, and 3) perceived barriers and facilitators to optimal pain care. We conducted a mixed-methods convergent parallel study involving an online survey and semistructured interviews. We analyzed the data from each method separately and integrated the findings. One hundred sixty-four adults completed the survey and 17 adults completed the semistructured interviews. We found large or moderate-sized correlations between greater selfreported social isolation and poorer health outcomes. Experiencing a higher number of adverse SDH was moderately correlated with lower quality of life and was significantly correlated with all other outcomes. We generated 5 themes from the qualitative analysis: active strategies are important for well-being; low agency; facilitators of optimal care; barriers to optimal care; and health inequities, and derived meta-inferences that highlight the complex inter-relationships between the SDH and health outcomes in this cohort. The findings of our study can importantly inform endeavors to improve equity of pain care for adults with low back pain or spinal cord injury and persistent pain. PerspectiveThis study illustrates the complex interplay between adverse social determinants of health and poorer health status for adults with persistent pain and provides evidence to support the important role of social isolation. Developing an understanding of the life-contexts of those seeking care is a vital step towards addressing health inequities.

Impact of Race, Ethnicity, and Socioeconomic Status on Nasopharyngeal Carcinoma Disease-Specific and Conditional Survival.

Introduction Race, ethnicity, and socioeconomic status (SES) are complex, interconnected social determinants of health outcomes. This study uses multivariable analysis on a combination of large national datasets to examine the effects of these factors on 5-year disease-specific survival (DSS) and conditional DSS (CDSS) for nasopharyngeal carcinoma (NPC). Methods A retrospective study of adults with NPC between 2000 and 2017 from the Surveillance, Epidemiology, End Results (SEER) registry was performed, using the National Cancer Institute Yost Index, a census tract-level composite score of SES to categorize patients. Kaplan-Meier analysis and Cox's regression for DSS and CDSS were stratified by SES. Logistic regression was conducted to identify risk factors for advanced cancer stage at time of diagnosis and receiving multimodal therapy. Results Our analysis included 5,632 patients. DSS was significantly associated with race and SES ( p < 0.01). Asian/Pacific Islander patients exhibited increased survival when controlling for other variables (hazard ratio [HR] = 0.73, p < 0.01). Although Black patients were more likely to be diagnosed with advanced disease (Black odds ratio [OR] = 1.47, p < 0.01), Black patients were also less likely to receive multimodal therapy; however, this relationship lost statistical significance once SES was incorporated into the multivariable analysis. DSS was decreased among the lowest (first) and middle (second) tertiles of SES (first HR = 1.34, p < 0.01; second HR = 1.20, p < 0.01) compared with the highest (third). Conclusion Our results indicate that race, ethnicity, and SES significantly affect survival, stage at diagnosis, and treatment of NPC. An interplay of tumor biology and inequalities in access to care likely drives these disparities.

Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review

BackgroundLocally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments.MethodsSystematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR).ResultsThirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms – can all have positive impacts on health outcomes – particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear.ConclusionsPlace-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities.Trial registrationPROSPERO CRD42019158309

Social capital, access to healthcare, and health-related quality of life in urban Ghana

ABSTRACT This study examines the status and relationship amongst social capital, access to healthcare and health-related quality of life (HRQoL) of urban residents in Ghana. It also explores the moderating role of social capital in the association between access to healthcare and HRQoL of urban residents in Ghana. Data from 1,233 adults were derived from a cross-sectional survey on social epidemiology in five regions and were analyzed using ordinal logistic regression models. Approximately 24.1% of the respondents had low access to healthcare. We found that 41.8% and 10.1% of them rated their health as average and poor, respectively. Access to healthcare (B = 0.777, p < .001) and bridging social capital (B = 0.281, p < .01) were positively associated with HRQoL. However, linking social capital was negatively related to HRQoL (B = −0.199, p < .01). Bridging social capital (B = 0.435, p < .01) positively moderated the association between access to healthcare and HRQoL. The study expands our understanding of social determinants of health outcomes. It proffers that universal health coverage interventions in urban Ghana should actively but cautiously leverage available social resources to improve population health.

Geographic Differences and Social Determinants of Health Among People With HIV Attributed to Injection Drug Use, United States, 2017.

People who inject drugs are among the groups most vulnerable to HIV infection. The objective of this study was to describe differences in the geographic distribution of HIV diagnoses and social determinants of health (SDH) among people who inject drugs (PWID) who received an HIV diagnosis in 2017. We used data from the National HIV Surveillance System (NHSS) to determine the counts and percentages of PWID aged ≥18 with HIV diagnosed in 2017. We combined these data with data from the US Census Bureau's American Community Survey at the census tract level to examine regional, racial/ethnic, and population-area-of-residence differences in poverty status, education level, income level, employment status, and health insurance coverage. We observed patterns of disparity in HIV diagnosis counts and SDH among the 2666 PWID with a residential address linked to a census tract, such that counts of HIV diagnosis increased as SDH outcomes became worse. The greatest proportion of PWID lived in census tracts where ≥19% of the residents lived below the federal poverty level, ≥18% of the residents had <high school diploma, the median annual household income was <$40 000, and ≥16% of the residents did not have health insurance or a health coverage plan. To our knowledge, our study is the first large-scale, census tract-level study to describe SDH among PWID with diagnosed HIV in the United States. The findings of substantial disparities in SDH among people with HIV infection attributed to injection drug use should be further examined. Understanding the SDH among PWID is crucial to reducing disparities in HIV diagnoses in this population.

Returning to our roots: The use of geospatial data for nurse-led community research.

In the early 20th century, public health nurse, Lillian Wald, addressed the social determinants of health (SDOH) through her work in New York City and her advocacy to improve policy in workplace conditions, education, recreation, and housing. In the early 21st century, addressing the SDOH is a renewed priority and provides nurse researchers with an opportunity to return to our roots. The purpose of this methods paper is to examine how the incorporation of geospatial data and spatial methodologies in community research can enhance the analyses of the complex relationships between social determinants and health. Geospatial technologies, software for mapping and working with geospatial data, statistical methods, and unique considerations are discussed. An exemplar for using geospatial data is presented regarding associations between neighborhood greenspace, neighborhood violence, and children's asthma control. This innovative use of geospatial data illustrates a new frontier in investigating nontraditional connections between the environment and SDOH outcomes.

Can interactive science exhibits be used to communicate population health science concepts?

ABSTRACTEngaging public audiences with population health science necessarily requires a society level perspective; however, many existing communication strategies and programs tend to focus at the individual level. This paper describes a novel approach to engaging community members with the social determinants of health outcomes using an interactive exhibit within a science centre. The exhibit was capable of supporting understanding about social determinants of health in adults and children under the age of 15 within an average three-minute interaction. The presence of a facilitator who guided and supported discussions about the exhibit and its concepts with the visitors was also key to sustaining visitor engagement. These exploratory findings suggest the use of informal learning settings, such as science centres and museums, may provide a means to communicate population health and improve discourse about public health policy.

Disparities in social determinants of health outcomes and behaviours between older adults in Alaska and the contiguous US: evidence from a national survey

ABSTRACT Few studies have focused on understanding how sociodemographic factors impact healthy ageing in the rapidly growing population of Alaskan older adults. Therefore, the objectives of this study are to compare the health of Alaskan older adults to those in the contiguous US, and determine how the associations differ between older adults in Alaska and the contiguous US. We abstracted 165,295 respondents age 65+ from the 2016 Behavioral Risk Factor Surveillance System. We used generalised linear models to assess the associations between sociodemographic factors and six health outcomes accounting for confounders and complex sampling. In the contiguous US, females were less likely than males to be obese (OR 0.96, 95%CI 0.96–0.97), while in Alaska, females were more likely to be obese (OR 1.24, 95%CI 1.19–1.29). In the contiguous US, Alaska Natives/American Indians were more likely than respondents of other races to be smokers (OR 1.62, 95%CI 1.60–1.63), while in Alaska, the association between race and smoking was not significant (OR 1.00, 95%CI 0.94–1.06). These differences between Alaska and the contiguous US results suggest that programs designed to reduce disparities and promote healthy behaviours may need to be tailored to meet the unique needs and challenges of older adults living in Alaska.

Fetal Hemoglobin Level during Hydroxyurea Therapy Varies By Neighborhood

BackgroundPlace is a contributor to overall health in the United States. Health disparities exist in relation to spatial variables, and minorities and people who live below the Federal Poverty Level (FPL) experience the greatest burden. Most individuals with sickle cell disease in the U.S. are minorities, signaling an increased likelihood of exposure to the deleterious impact of social determinants of health. Because the impact of social determinants of health outcomes is not well investigated in sickle cell disease, we sought to create a model to investigate the relationship between contextual factors and clinical outcomes. Specifically, we investigated the variability of fetal hemoglobin (HbF) level during hydroxyurea therapy in a longitudinal cohort of patients with sickle cell anemia (SCA). We hypothesized that patients living in neighborhoods with lower Economic Hardship Index (EHI) would have lower HbF in comparison with those living in places with higher EHI scores.MethodsWe included patients with SCA who are participants of the longitudinal natural history study, Sickle Cell Clinical Research and Intervention Program (Hankins et al. Pediatr Blood Cancer. 2018 May 24:e27228.), who 1) lived in Shelby County, Tennessee, 2) were treated with hydroxyurea, and 3) had at least one HbF value recorded. Using ArcGIS, participant addresses were geocoded then aggregated by U.S. Census Block Group (CBG). Geospatial analysis was conducted to identify clustering of HbF values using Cluster and Outlier Analysis (Anselin Local Moran's I), High/Low Clustering (Getis-Ord GeneralG), and Hot Spot Analysis (Getis-Ord Gi*). Geographically-weighted regression was used to test explanatory variables for identified clusters. The main outcome variables were peak, minimum, and average HbF during hydroxyurea therapy at the CBG level. Mean HbF the average of all HbF lab values for the duration of treatment, the peak HbF was recorded at hydroxyurea maximum tolerated dose, and minimum HbF was the lowest record value during treatment. Spatial regression was used to examine factors associated with HbF at the individual level (demographics, genotype, and duration of hydroxyurea therapy).ResultsA total of 202 SCCRIP participants (HbSS N=187; HbSβ0-Thalassemia, N=14; other, N=1) were identified during the years 1996 and 2017. The median age (range: 0.8-25.3 years) was 12 years. Participant addresses were geocoded within 147 (23.4%) of the 628 CBGs within Shelby County. Mean (SD) duration of hydroxyurea therapy was 5.4 (±4.8) person-years, mean, maximum, and minimum HbF was 23.6% (SD±10.8), 52.2% (SD±25.9) and 12.9% (SD±9.7), respectively. Thirty-nine percent of participants lived in a census block group with high to very high EHI scores (i.e., increased economic hardship as measured by U.S. Census data) and 19.3% lived within a CBG where >40% of households fall below the federal poverty level (FPL).Age was a significant predictor of peak [(F(1,200)=191.34, p<0.001, R2=.489], mean [(F(1,200)=118.99, p<0.001), R2 =0.373], and minimum HbF [(F(1,200)=58.33, p<0.001, R2=.226]. However, mean age was randomly distributed throughout the study area without significant clustering at the CBG level (Observed General G=0.0068, z-score=0.313, p=0.754). Hot Spot Analysis (Getis-Ord Gi*) found significant clustering of HbF values at the CBG level (Figure): higher HbF clustered with CBGs above the FPL and lower HbF clustering with CBGs below the FPL. While there was differential HbF clustering at the CBG level when stratified by EHI, the geographically weighted regression did not find a significant relationship between EHI and HbF levels.ConclusionGeospatial analysis indicates geographic variation in HbF% levels among individuals with SCA living in Shelby County, TN. Clustering of higher HbF trended towards neighborhoods with lower EHI while clustering of lower HbF trended toward neighborhoods with higher EHI, suggesting a role of the environment on response to hydroxyurea therapy. Although this study did not investigate the mechanism whereby economic hardship may influence HbF production during hydroxyurea therapy, our findings suggest a possible link between poverty and medication adherence. Our findings point toward the importance of tailoring hydroxyurea therapy to contextual factors, such as neighborhood types, informing community-level interventions. [Display omitted] DisclosuresEstepp:Daiichi Sankyo: Consultancy; NHLBI: Research Funding; ASH Scholar: Research Funding; Global Blood Therapeutics: Consultancy, Research Funding. Hankins:Novartis: Research Funding; Global Blood Therapeutics: Research Funding; bluebird bio: Consultancy; NCQA: Consultancy.

EDITORIAL COMMENT

The authors compared the operative time and 30-day complication rate of over 30,000 general urologic procedures performed at academic and community hospitals using the NSQIP database with and without trainee involvement. They found that for general urology procedures, resident involvement was correlated with longer operative time as expected, but also surprisingly an increased rate of 30-day complications which was not explained by a sicker patient population; in fact, the patients with no trainee involvement had a higher rate of medical comorbidities. Notable factors that could not be analyzed were year of resident training and socioeconomic status of the patients as social determinants of health outcomes are powerful factors that influence access, healthcare delivery and outcome.

Cross-sectional analysis of two social determinants of health in California cities: racial/ethnic and geographic disparities

ObjectiveTo study the magnitude and direction of city-level racial and ethnic differences in poverty and education to characterise health equity and social determinants of health in California cities.DesignWe used data...

Medical-Legal Partnership: Prevention, Access to Justice and the Next Generation of Legal and Healthcare Professionals.

Inequality of access to legal services is a significant problem in Australia. In a panel discussion Dr. Curran of the Australian National Research gave a short paper responding to the key note address by Liz Tobin Tyler, Adjunct Professor, the Roger Williams University School of Law in Rhode Island and Assistant Professor of Family Medicine at the Alpert Medical School of Brown University and of Health Services, Policy and Practice at the Brown University School of Public Health on the topic ‘Medical-legal partnership: Prevention, access to justice and the next generation of legal and healthcare professionals.’In the response Dr. Curran noted similarities and difference between the USA and Australia and reports on her participatory action research that ANU has been commissioned to undertake in a range of Health Justice Partnerships (HJP) including the embedded research evaluation of ACR Justice Bendigo pilot of an HJP which commenced in January 2015. The Executive Officer of ARC Justice, Peter Noble has also asked Dr. Curran to measure impacts of the HJP on the social determinants of health which she is grappling with given international recognition of the challenge. Dr. Curran has come up with some tools informed by affected community, service providers and international research in an action research collaborative approach within a continuous learning, reflection and development model and is using these to measure in concrete terms the social determinants of health outcomes from the HJP. Dr. Curran discussed a number of Australian HJP evaluations in terms of quality, impact, outcomes and the social determinants of health. She discusses tools and some preliminary findings in the various research projects which are ongoing.

Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio

American Heart Association (AHA) public policy advocacy strategies are based on its Strategic Impact Goals. The writing group appraised the evidence behind AHA's policies to determine how well they address the association's 2020 cardiovascular health (CVH) metrics and cardiovascular disease (CVD) management indicators and identified research needed to fill gaps in policy and support further policy development. The AHA policy research department first identified current AHA policies specific to each CVH metric and CVD management indicator and the evidence underlying each policy. Writing group members then reviewed each policy and the related metrics and indicators. The results of each review were summarized, and topic-specific priorities and overarching themes for future policy research were proposed. There was generally close alignment between current AHA policies and the 2020 CVH metrics and CVD management indicators; however, certain specific policies still lack a robust evidence base. For CVH metrics, the distinction between policies for adults (age ≥20 years) and children (<20 years) was often not considered, although policy approaches may differ importantly by age. Inclusion of all those <20 years of age as a single group also ignores important differences in policy needs for infants, children, adolescents, and young adults. For CVD management indicators, specific quantitative targets analogous to criteria for ideal, intermediate, and poor CVH are lacking but needed to assess progress toward the 2020 goal to reduce deaths from CVDs and stroke. New research in support of current policies needs to focus on the evaluation of their translation and implementation through expanded application of implementation science. Focused basic, clinical, and population research is required to expand and strengthen the evidence base for the development of new policies. Evaluation of the impact of targeted improvements in population health through strengthened surveillance of CVD and stroke events, determination of the cost-effectiveness of policy interventions, and measurement of the extent to which vulnerable populations are reached must be assessed for all policies. Additional attention should be paid to the social determinants of health outcomes. AHA's public policies are generally robust and well aligned with its 2020 CVH metrics and CVD indicators. Areas for further policy development to fill gaps, overarching research strategies, and topic-specific priority areas are proposed.

Evaluating the health inequalities impact of area-based initiatives across the socioeconomic spectrum: a controlled intervention study of the New Deal for Communities, 2002–2008

BackgroundPrevious evaluations of area-based initiatives have not compared intervention areas with the full range of areas from top to bottom of the social spectrum to evaluate their health inequalities impact.SettingDeprived...

Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review.

Social determinants of health include the social and economic conditions that influence health status. Research into the impact of social determinants on individuals with type 2 diabetes has largely focused on the prevention of or risk of developing diabetes. No review exists summarizing the impact of social determinants of health outcomes in patients with type 2 diabetes. This systematic review examined whether social determinants of health have an impact on health outcomes in type 2 diabetes. Medline was searched for articles that (a) were published in English (b) targeted adults, ages 18 + years, (c) had a study population which was diagnosed with type 2 diabetes, (d) the study was done in the United States, and (e) the study measured at least one of the outcome measures-glycemic control, cholesterol (LDL), blood pressure, quality of life or cost. Using a reproducible strategy, 2,110 articles were identified, and 61 were reviewed based on inclusion criteria. Twelve were categorized as Economic Stability and Education, 17 were categorized as Social and Community Context, 28 were categorized as Health and Health Care, and three were categorized as Neighborhood and Built Environment. Based on the studies reviewed, social determinants have an impact on glycemic control, LDL, and blood pressure to varying degrees. The impact on cost and quality of life was not often measured, but when quality of life was investigated, it did show significance. More research is needed to better characterize the direct impact of social determinants of health on health outcomes in diabetes.