Health Disparities in Hand and Upper Extremity Surgery: A Scoping Review
Kevin Chen, BA; Grace Y. Duan, BA; Jeffrey G Stepan, MD, MS
University of Chicago, Chicago, IL
Introduction: Hand surgeons provide care to a diverse population. Although social determinants of health (SDOH), such as race/ethnicity, education, and deprivation indices, have been linked to poor healthcare outcomes, there is a paucity of research assessing health disparities within hand surgery. Thus, we conducted a scoping review to understand the existing literature and identify further areas for research.
Methods: We conducted a systematic search of PubMed, Scopus, and Cochrane according to PRISMA guidelines. Inclusion criteria were English studies pertaining to health disparities in hand surgery. The following attributes were assessed: main disease/injury/procedure, SDOH, and study design/phase/theme. The framework for health disparities research by Kilbourne (2006) was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Themes were categorized based on the National Institute of Health – American College of Surgeons (NIH-ACS) Summit on Surgical Disparities: clinician factors, patient factors, systemic/access factors, clinical quality factors, and postoperative care and rehabilitation-related factors. Descriptive analysis and study trends were assessed.
Results: The initial search yielded 446 articles and 48 articles were included in final analysis. Of studies assessing one SDOH, the three most studied were insurance status (n=13;32.5%), health literacy (n=10;25%), and social deprivation (n=6;15%). Of studies assessing one disease/injury, the three most studied were carpal tunnel (n=9;18.8%), upper extremity trauma (n=9;18.8%), and amputation (n=5;10.4%). Regarding ACS themes, most studies assessed patient factors (n=31;57.4%) and systemic/access factors (n=15;27.8%), while few assessed clinical quality factors (n=4;7.4%), clinician factors (n=3;5.6%), and post-operative/rehabilitation-related factors (n=1;1.9%). Most studies had retrospective or database designs (n=28;58.4%). Studies identifying and analyzing risk factors comprised 87.5% of the studies (detecting phase=62.5%; understanding phase=25%). Only 6 (12.5%) were in the reducing phase assessing interventions.
Conclusions: Despite an encouraging upward trends in health disparities research, existing studies are in the early phases of investigation (detecting/understanding). Most studies relied on retrospective review and databases, while few were prospective, cross-sectional, or mixed-methods. Furthermore, few studies examined access to postoperative rehabilitation, which are vital for patient recovery – especially in the setting of traumatic injury. Further work is needed to better understand social factors contributing to poor hand surgery outcomes and inform future interventions.
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