Social Determinants of Health: A Critical Factor in Adult Traumatic Brachial Plexus Injury Outcomes
Samantha Maasarani, M.D., M.P.H.1, Corinne Wee, M.D.1, Syed I Khalid, MD2 and Shelley S. Noland, MD3, (1)Cleveland Clinic, Cleveland, OH, (2)Rush University Medical Center, Chicago, IL, (3)Department of Orthopaedics and Sports Medicine, Mayo Clinic, Phoenix, AZ
Introduction: Over the past three decades, there has been a rapid accumulation of evidence citing social determinants of health (SDOH) as inherent causes for an array of health outcomes; however, there is a paucity of literature examining the implications adult traumatic brachial plexus injuries (TBPIs) may have on populations already experiencing health inequities prior to this life-altering injury. This study examines how SDOH disparities influence the risk of developing new psychosocial conditions after TBPIs in previously psychiatric-na´ve patients.
Methods: Between January 2010-June 2019, a retrospective analysis was performed using PearlDiver's Mariner, an all-payer claims database. One-to-one exact matching based on baseline patient demographics was completed, creating three identical groups:
- TBPI disparity cohort: patients with TBPI and presence of at least one SDOH disparity prior to injury:
- economic instability
- food insecurity
- inadequate education
- community and social context problems
- inaccessible healthcare facilities
- neighborhood and physical environment issues
- TBPI without disparity cohort: patients with TBPI and the absence of any SDOH disparity.
- Control cohort: patients without TBPIs.
The following primary psychosocial outcomes were included in our study: depression, anxiety, drug abuse, alcohol abuse, suicide attempt, post-traumatic stress disorder, and divorce.
Results: The matched population analyzed in this study consisted of 1,176 patients that were equally represented in the TBPI disparity cohort (n=392, 33.33%), TBPI without disparity cohort (n=392, 33.33%), and control cohort (n=392, 33.33%). A total of 301 patients developed any psychosocial condition with four-years of their injury. Patients in the TBPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, p<0.0005), depression (22.70%, p=0.0032), anxiety (18.62%, p=0.0203), drug abuse (7.91%, p=0.0060), and alcohol abuse (4.85%, p=0.03499) when compared to the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (HR 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups.
Conclusion: TBPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Clinicians should routinely screen for psychiatric conditions and assess relevant social factors to improve identification of at-risk patients. A multidisciplinary approach incorporating medical, surgical, social, and psychological experts should be considered when managing these injuries.
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