Social Determinants Of Health Research Articles

Impact of social determinants of health on hepatocellular carcinoma surveillance, treatment, and health care costs.

The impact of clinical factors and social determinants of health on treatment patterns and health care costs among patients with HCC is unknown. Using 100% Medicare Fee-For-Service claims and a commercial multipayor claims database, we identified patients diagnosed with HCC from January 1, 2017, to December 31, 2020. Surveillance receipt was defined 12 months prior to HCC diagnosis, whereas treatment and health care costs were assessed post-HCC diagnosis. Multinomial logistic regression was used to assess the association between demographics, social determinants of health, and surveillance or HCC treatment. Multivariable generalized linear regression was used to identify factors associated with total health care costs. Of the 32,239 patients with HCC (mean age 68 y, 67% male, 73% White), 70% received surveillance and only half (51%) received any treatment. Curative treatment receipt was higher among those with prior surveillance (24% with CT/MRI and 18% with ultrasound vs. 9% with no surveillance). Curative treatment was independently associated with HCC surveillance and inversely associated with Black race, lower education level, and diagnosis in the year 2020 (COVID-19 year). Higher health care costs were independently associated with Black race, low English proficiency, living alone, and diagnosis in 2018-2020, and inversely associated with CT/MRI-based surveillance. Race and social determinants of health were independently associated with curative treatment receipt and health care costs. Increasing access to high-quality HCC surveillance may improve treatment receipt and reduce health disparities among patients with HCC.

Addressing Social and Structural Determinants of Health in the Delivery of Reproductive Health Care: ACOG Committee Statement No. 11.

Social and structural determinants of health include historical, social, political, and economic forces, many of which are rooted in racism and inequality, that shape the relationship between environmental conditions and individual health. Unmet social needs can increase the risk of many conditions treated by obstetrician-gynecologists (ob-gyns), including, but not limited to, preterm birth, unintended pregnancy, infertility, cervical cancer, breast cancer, and maternal mortality. An individual health care professional's biases (whether overt or unconscious) affect delivery of care and may exacerbate and reinforce health disparities through inequitable treatment. Obstetrician-gynecologists and other health care professionals should seek to understand patients' health care decision making not simply as patients' individual-level behavior, but rather as the result of intersecting sociopolitical conditions, structural inequities, and social needs that create and maintain inequalities in health and health care. Recognizing the importance of social and structural determinants of health can help ob-gyns and other health care professionals to better understand patients, effectively communicate about health-related conditions and behavior, and contribute to improved health outcomes, including patients' experience of care and their trust in the health care system.

Neighborhood Disadvantage Predicts Delay in Care in Bilateral Breast Reduction.

The Area Deprivation Index (ADI) is a validated quantifiable measure of neighborhood disadvantage and social determinants of health (SDoH). Higher percentiles in ADI correlate with the most disadvantaged neighborhoods: lower income, lower education, and less access to transportation. Using ADI, we aimed to investigate the impact of SDoH on bilateral breast reduction (BBR) complication rates. A retrospective study of BBR patients from 2015 to 2021 was conducted. Patient addresses were matched to ADI percentiles and grouped into most (top 80% ADI) and least disadvantaged. Multivariable regressions were used to compare postoperative treatment between groups and adjust for confounders. In total, 568 patients were analyzed and 47% were high ADI. Time-to-event analysis revealed a 155% (β = 2.55; CI, 1.87-3.48; P < 0.001) increase in time to presentation for treatment of wound-related complications among higher-deprivation patients compared to their lower-deprivation counterparts. This difference in time to presentation equated to approximately 3 days overall when comparing higher to lower deprivation patients; however, this difference between the groups increased to 12 days when comparing those who experienced wound-related complications beyond day 30. High deprivation was associated with increased delays to treatment after complications. More research is needed to determine the factors that impact postoperative courses among high ADI patients.

Decoding health disparities: An analysis of endometrial TP53 mutations, race, and social determinants of health

Decoding health disparities: An analysis of endometrial TP53 mutations, race, and social determinants of health

The impact of environmental factors and social determinants of health on mismatch repair status in a single-center endometrial cancer cohort

The impact of environmental factors and social determinants of health on mismatch repair status in a single-center endometrial cancer cohort

Building decolonial nursing curricula to address disparities in Indigenous women's maternal health

Social and health inequities and inequalities are rising all over the world (Smith, 2012; McGibbon et al., 2014; Chinn and Falk‐Rafael, 2018). Nursing students should therefore be educated to understand the multifaceted factors creating health inequities and the degree to which non-biological elements can be embodied and become biological (e.g., environmental stress leading changes in health.). The need for innovative undergraduate nursing curricula reform is apparent. The lack of nursing courses highlighting the effects of colonization, environmental justice, upstream structural and social determinants of health, globalization, and state violence must be addressed. Colonization, broadly speaking, characterizes the Eurocentric project to “civilize” the rest of the world utilizing various forms of violence (McGibbon et al., 2014). The persistent and ongoing reproduction and recurrence of colonialism, enacting cycles of disenfranchisement and oppression, creates significant inequities in physical, mental, and emotional health and well-being for historically marginalized groups of people (Smith, 2012). Because gaps in nursing curricula and outdated teaching practices may support persistent inequities, scholars and students have advocated for decolonization of nursing curricula (Smith, 2012; McGibbon et al., 2014; Chinn and Falk‐Rafael, 2018). This analysis utilizes decolonial theory and postcolonial feminism to suggest pathways to decolonize nursing curricula and pedagogy through decentering the colonial knowledge structures and practices that harm Indigenous health and wellbeing.

The Role of Health Systems in Cross-Sector Collaboration in Addressing Social Determinants of Health and Promoting Health and Well-Being.

The articles featured underscore the critical role of trust, strategic planning, and cross-sector partnerships in addressing health inequities, while emphasizing the need for further research on sustainable and cost-effective collaboration models. Tocco and colleagues from Northwell Health describe the formation of the Health Equity Taskforce (HET), initially aimed at equitable COVID-19 vaccine distribution on Long Island. The HET has since expanded to address broader health disparities, focusing on community involvement, strategic partnerships, and sustainability. Nemiroff and colleagues discuss collaborations with community partners and payors to address social determinants of health in underserved populations, highlighting opportunities that can facilitate collaborations such as the New York State's Medicaid 1115 Demonstration Waiver.

A retrospective analysis of the social determinants of health and impact on overall survival among patients with vulvar cancer

A retrospective analysis of the social determinants of health and impact on overall survival among patients with vulvar cancer

The Effects Of Social Determinants Of Health Among Patients Undergoing Shoulder Stabilization Surgery

The Effects Of Social Determinants Of Health Among Patients Undergoing Shoulder Stabilization Surgery

The Role of Health Systems in Cross-Sector Collaboration in Addressing Social Determinants of Health and Promoting Health and Well-Being.

The articles featured underscore the critical role of trust, strategic planning, and cross-sector partnerships in addressing health inequities, while emphasizing the need for further research on sustainable and cost-effective collaboration models. Tocco and colleagues from Northwell Health describe the formation of the Health Equity Taskforce (HET), initially aimed at equitable COVID-19 vaccine distribution on Long Island. The HET has since expanded to address broader health disparities, focusing on community involvement, strategic partnerships, and sustainability. Nemiroff and colleagues discuss collaborations with community partners and payors to address social determinants of health in underserved populations, highlighting opportunities that can facilitate collaborations such as the New York State's Medicaid 1115 Demonstration Waiver.

Extreme Heat and Chronic Disease: Improving Patient Outcomes

Primary care providers play a crucial role in understanding and addressing the impacts of climate change on chronic diseases and patient outcomes. This clinical scenario introduces the concept of climate change impacting care and underscores the importance of understanding social determinants of health. Collaboration with patients, community leaders, and policymakers can bring about change and improve the quality of care all patients need. Providers must be empowered with this knowledge and take responsibility for the health of their patients and the planet.

Mental health and well-being in prisons and places of detention.

This study aims to address the critical mental health challenges faced by individuals in prisons and places of detention. By introducing and validating a novel conceptual framework that integrates social determinants of health with the stress process model, this study aims to provide actionable insights for improving mental health care in correctional settings. The research seeks to inform policymakers, prison administrators and mental health professionals about effective interventions and systemic reforms that can reduce recidivism, enhance rehabilitation and promote a more humane and just criminal justice system. This study uses a multi-method research design integrating a systematic literature review, qualitative interviews, multi-criteria evaluation (MCE) and a small-scale empirical study within a correctional facility. The systematic review follows PRISMA guidelines, analysing peer-reviewed articles, government reports and policy documents. Semi-structured interviews with 25 mental health professionals provide practical insights, whereas the MCE assesses intervention effectiveness based on expert consensus. The empirical study involves baseline assessments, intervention implementation and follow-up evaluations using validated tools, providing robust data to validate the proposed conceptual framework that integrates social determinants of health with the stress process model. This study finds that mental health disorders are significantly more prevalent in prison populations than in the general population, with interventions like cognitive behavioural therapy (CBT), peer support programs and trauma-informed care showing considerable effectiveness in reducing symptoms. Emerging technologies such as AI and telemedicine present promising avenues for enhancing care but require careful ethical consideration. The research also highlights the critical role of social determinants and the importance of systemic reforms, such as reducing solitary confinement and integrating prison health care with broader public health systems, in improving inmate mental health and reducing recidivism. This study's quasi-experimental design, while robust, may limit the generalizability of the findings to other correctional settings because of specific facility characteristics. Additionally, the sample size for qualitative interviews, although diverse, could have been larger to provide more nuanced insights, particularly for underrepresented groups. This study highlights the need for more longitudinal research to assess the long-term effects of interventions and the scalability of approaches across different cultural and legal contexts. Future studies should address these limitations by using more diverse sampling, larger sample sizes and extended follow-up periods. This study provides actionable insights for policymakers and prison administrators, emphasizing the need to integrate evidence-based mental health interventions, such as CBT and trauma-informed care, into prison reform strategies. It highlights the importance of training correctional staff in mental health first aid and the potential of emerging technologies like AI and telemedicine to enhance care delivery in resource-limited settings. Implementing these recommendations could significantly improve inmate mental health outcomes, reduce recidivism rates and promote a more humane and effective correctional system, with broader benefits for public health and social equity. Improving mental health care in prisons has significant social implications, particularly in promoting social justice and reducing inequalities. Effective mental health interventions can help break the cycle of incarceration and recidivism, particularly in marginalized communities disproportionately affected by the criminal justice system. By addressing the mental health needs of incarcerated individuals, society can foster safer communities, reduce crime rates and alleviate the economic burden on the criminal justice and health-care systems. Furthermore, enhancing mental health care in prisons reflects a commitment to human dignity, fairness and the rehabilitation of offenders, contributing to a more just and compassionate society. This study introduces a novel conceptual framework that integrates social determinants of health with the stress process model, specifically tailored for correctional facilities. It provides original empirical data from a real-world prison setting, offering new insights into the effectiveness of mental health interventions, such as CBT and trauma-informed care. The study's value lies in its comprehensive approach, combining quantitative and qualitative methods, and its focus on underrepresented populations in correctional settings. By addressing significant gaps in the literature, this research offers practical recommendations for policymakers and practitioners, contributing to improved mental health outcomes and reduced recidivism.

Social and environmental determinants of sleep health disparities

Abstract Sleep is not equitable. Historically minoritized individuals have a high prevalence of sleep disorders and adverse sleep health. Research supports that social determinants of health are contributing to sleep health inequities. Further, sleep is socially patterned. Neighborhoods with high rates of crime, violence, disadvantage, pollution, inopportune light exposure, and noise, where historically minoritized individuals are most likely to live are associated with adverse sleep health and sleep disorders. Social determinants including discrimination, racism, socioeconomic status, lack of access to care are associated with adverse sleep health, particularly among minoritized individuals. While there is an abundance of evidence identifying risk factors for adverse sleep health, evidence also supports factors that promote healthy sleep. A small but growing literature supports that neighborhood social environment is associated with healthy sleep and may be avenue for addressing sleep disparities. Dr. Johnson will present epidemiologic data on the social and environmental determinants of adverse sleep health using a socioecological framework and discuss the mechanisms by which these factors are contributing to sleep disparities. The goal is to identify these factors, and how they can be utilized to address sleep health disparities.

Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States

Abstract Objectives The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States. Methods Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients. Results TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better. Conclusions We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.

Social determinants of health, blood pressure classification, and incident stroke in community-dwelling adults: a prospective cohort study

Abstract Objective To determine whether the association of blood pressure (BP) categories, defined by the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline, with stroke differ among Chinese adults with low or high burden of unfavorable social determinants of health (SDOH). Design and Methods: Analyses were conducted in the prospective sub-cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, started in 1, July 2017 and followed stroke events until 31, June 2023. Participants were divided into groups with low and high burden of unfavorable SDOH, which consisted of educational attainment, economic stability, health care access, social support, and neighborhood relationship. Within each group, participants were categorized as having normal BP (systolic BP [SBP] &amp;lt;120 mm Hg and diastolic BP [DBP] &amp;lt;80 mm Hg), elevated BP (SBP 120-129 mm Hg and DBP &amp;lt;80 mm Hg), stage 1 hypertension (SBP 130-139 mm Hg or DBP 80-89 mm Hg), and stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90mm Hg). The association between BP categories and stroke risk were examined within each SDOH group, separately, using multivariable-adjusted Cox proportional hazards models. Results Of the 96,686 adults included in this study (mean [SD] age, 53.8 [10.1] years; 59,080 [61.1%] women), 64,823 (67.0%) were categorized as having high burden of unfavorable SDOH. Over a median follow-up of 5.0 years, 4,673 (4.8%) incident stroke events occurred. In the group of low burden of SDOH, hazard ratios (95% CI) for stroke events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.09 (0.86-1.37), 1.14 (0.94-1.37), and 1.59 (1.33-1.90), respectively. In the group of high burden of SDOH, hazard ratios for stroke events for elevated BP, stage 1 hypertension, and stage 2 hypertension vs normal BP were 1.20 (1.04-1.38), 1.45 (1.29-1.62), and 1.71 (1.53-1.91), respectively. Results were similar after excluding those taking antihypertensive medications. Conclusion Lower BP categories were closely associated with increased risk of stroke in the context of high burden of SDOH. Early counseling and surveillance of high BP should be emphasized within socioeconomically disadvantaged populations.

Understanding labour exploitation as a social determinant of health in migrant populations – insights from the Danish population-based registers

Abstract Despite recent global events such as the COVID-19 pandemic and the Qatar world cup drawing attention to the significant loss of human lives of labour migrants in precarious working conditions, evidence on the comparative mortality of migrant workers remains sparse and inconsistent. Studying the comparative mortality of migrant workers with local workers is challenging for several reasons. Data on migrants’ employment conditions and health outcomes are often incomplete, and when available captured in separate databases. In addition, there is a need to disentangle the healthy migrant effect from the healthy worker effect, which presents challenges in the selection of reference populations and temporality when studying mortality of migrants. In view of such challenges, Denmark provides an ideal context to study labour migration and mortality. The Danish population-based registers offer linked longitudinal data on migrants’ employment history and mortality outcomes. Denmark’s migrant integration policy also has a history of weaving immigration and labour policies, and migrants in Denmark continue to be prone to labour exploitation in high-risk industries such as construction and agriculture. This presentation shall use Denmark as a case study to compare the mortality outcomes of migrant workers with Danish workers to better understand labour exploitation as a social determinant of health.

Scoping Review of Health Literacy Interventions among Migrant Communities in Europe

Abstract Background The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language. Results Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach. Conclusions This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities. Key messages • Most European health literacy interventions for migrants target women and are conducted in North or West Europe. • Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.

Association Between Social Determinants of Health, COVID-19 Stressors, and Mental Health Among New York Residents Early in the Pandemic.

The COVID-19 pandemic is a disaster event. Exposure to stressors during and after disaster events is associated with negative mental health symptoms. To inform targeted COVID-19 recovery efforts, data are needed to understand which stressors play a key role in this relationship. Cross-sectional survey data (demographics, impacts of COVID-19, social determinants of health, depression, and anxiety) were collected online from adults living in New York state between May and June 2020. Differences in the proportion of stressors (COVID-19 and social determinants) experienced by race/ethnicity were assessed using chi-square analyses. Logistic regression was used to assess which factors were associated with increased odds of depression and anxiety. A majority (n = 258, 62.2%) of the 415 respondents reported being directly impacted by the pandemic. Non-white respondents reported a significantly larger proportion of stressors compared to white respondents. Under half of respondents reported depression (n = 171, 41.2%) and anxiety (n = 164, 39.5%). Healthcare and food concerns were associated with increased odds of depression and anxiety, and economic concerns were associated with increased odds of anxiety. Findings underscore the need to respond to the COVID-19 mental health crisis by addressing social determinants of health.

3.D. Round table: Improving equity in health: Understanding and responding to health literacy as a social determinant

Abstract Evidence of a social gradient in health literacy has been found in all reported national population surveys in Europe. This workshop will examine the explanations for this social gradient and explore ways to optimise the contribution that health literacy makes in mediating the causes and effects of established social determinants of health. This will include consideration of practical approaches to improving health literacy in socially disadvantaged populations as a contribution to reducing health inequities within and across European countries. The workshop will explore the concept of critical health literacy and the potential to improve public awareness of and capacity to act on the wider social determinants of health. It will also draw upon existing evidence from interventions that demonstrate the feasibility of improving health literacy among higher-risk and diverse populations. This will include consideration of approaches to improving frontline professional skills and support; approaches to organizational and systems health literacy, working directly with people to develop critical skills in accessing, understanding and applying health information; and ensuring that in public health policy, priority is proportionate to need - reaching and engaging the population groups disproportionately affected by low health literacy. Recognising that research remains underdeveloped and the effects of interventions on health inequity are largely untested, the workshop will also consider where the most important research gaps exist and where future health literacy research should be prioritised. The workshop chair will provide introductory and summary remarks to the workshop. The co-chair will manage the panel discussion and audience participation in the workshop. The individual panel members will make 3-minute introductions to key issues from different perspectives examining the mediating and moderating role of health literacy in addressing the social determinants of health. The panel is made up of individuals from academic and policy roles and at different career stages who can offer complementary perspectives on these issues. Following the presentations, the co-chair will present some follow-up questions to the panel before engaging directly with the workshop participants for an open discussion scheduled to last for 30 minutes of the workshop. Key messages • Improving health literacy is not a panacea for entrenched inequities in health but can help moderate the impact on health of other social determinants and provide an important practical response. • Public health policy and practice intended to improve health literacy should prioritise reaching and engaging the population groups disproportionately affected by low health literacy. Speakers/Panelists Gill Rowlands Newcastle University, Newcastle, UK Stephan Van den Broucke Université Catholique de Louvain, Louvain-la-Neuve, Belgium Ana Rita Pedro NOVA National School of Public Health, Lisbon, Portugal Christina Dietscher Austrian Ministry of Health, Vienna, Austria Susie Sykes London South Bank University, London, UK

Cardiogenic shock is more prevalent in racialised and newcomer populations and associated with higher mortality

Abstract Background The World Health Organization (WHO) has recognised social determinants of health (SDH) as non-medical factors that affect health outcomes. These SDH have a significant effect on health inequities, whereby more marginalised populations often have worse outcomes due to unfair and avoidable differences in health status. The Ontario Marginalization index (ON-Marg) is an area-level index derived from 42 census variables identifying differences in marginalisation, allowing identification of inequities between population groups and geographical areas. The ‘racialised and newcomer populations’ dimension of the ON-Marg characterises the proportions of recent immigrants and/or people belonging to ‘visible minority’ groups in geographical locales. These data can be used as a surrogate for individual patient data to investigate health outcomes related to this dimension. This study investigated the prevalence and mortality associated with racial marginalisation in patients admitted with cardiogenic shock at a quaternary cardiac referral centre. Methods A single-centre registry of CS admissions from 2014-2023 at a quaternary referral centre cardiac intensive care unit (CICU) in Ontario, Canada was studied. Patient postal codes were identified and mapped to ON-Marg ‘racialised and newcomer populations’ data using the Postal Code Conversion File. The ON-Marg data are categorised into equal quintiles, which was used to determine differences in distribution of CS cases and inpatient survival using the Chi-squared test and Kaplan-Meier methods. Only the index CS hospitalisation was included in the analysis. Results We identified 1513 patients, including 456 (30.1%) females, aged 60.2±16.1 years, with 333 (24.8%) due to acute myocardial infarction CS. The majority of patients were SCAI stage D (69.2%) with 488 (32.3%) dying and 186 (12.3%) receiving a heart transplant or durable ventricular assist device (VAD) before discharge. CS patients were more likely to be in the higher quintiles for marginalisation racialised and newcomer populations and these individuals had higher mortality (p=0.005, figure 1). In a survival analysis, with right-censoring for transplant or VAD, there were significant differences between marginalisation quintiles (figure 2). Conclusions Patients admitted with CS to a large cardiac centre were more likely to be from populations with higher levels of racialised and newcomer individuals. Increasing marginalisation was associated with higher mortality. This identifies a need for delineating whether these differences are aetiological or whether there are barriers in accessing high-quality care in a timely fashion. This could allow an improvement in outcomes for these patient groups. While census-based area-level marginalisation indices can be helpful for identifying possible barriers to equitable care, individualised patient-level data are needed to confirm these findings.