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Do Social Determinants of Health Impact Wrist Fracture Patient Outcomes?
Karishma R Desai, BS
1, Anna Meyer, M.D.
1, Olivia Jagiella-Lodise, MD
2, Mara Schenker, MD, FACS
2; Nicole Zelenski, MD
2(1)Emory University, Atlanta, GA, (2)Emory School of Medicine, Atlanta, GA
Introduction: This study aims to identify whether social determinants of health (SDOH) affect subjective pain perceptions and outcomes of patients with a wrist fracture.
Methods: Social determinants of health and pain-related surveys, were administered to wrist fracture patients presenting to our Level 1 Trauma center at 2 weeks, 6 weeks, 3 months, and 6 months following surgical fixation for operatively managed patients, and from injury date for non-operatively managed patients. Composite scores were calculated for Financial Status, Social and Community Safety, Health Literacy, Substance Abuse, and Depression/Adverse Childhood Events (ACE) based on patient responses to SDOH questions, with greater scores corresponding to increased disadvantage in that category. Statistical analysis was performed using independent t-tests, then multiple linear regression was used to control for confounding variables.
Results: 47 patients total, 24 male, 23 female, 28 African-American. 34 (72.3%) managed operatively. 9 patients (19.1%) reported history of homelessness, 12 (25.5%) reported transportation issues, 20 (42.6%) responded it was "somewhat" or "very" difficult to afford basic necessities, and 8 (17.4%) said they worried about food insecurity. 10 (21.3%) were current smokers, and 9 (23.1%) had a diagnosis of neurological/psychiatric illness. Average composite scores for this cohort were: Financial Status 21%, Social/Community Safety 10.9%, Health Literacy 18.4%, Substance Abuse 19.8%, and Depression/ACE 19.3%.
Patients with a history of homelessness reported a higher pain score at 2 weeks (7 vs 4.03).
Patients who endorsed transportation issues reported a higher pain score at 6 weeks (5.14 vs 2.5).
Patients who reported financial difficulty reported a higher 2 week and 6 week pain score (6 vs 3.5), (5.2 vs 1.85), as well as a greater PROMIS Pain Interference score at 6 weeks (62.3 vs 52.9).
Additionally, patients who had a diagnosis of a neurologic or psychiatric illness reported greater PROMIS Sleep Disturbance at 2 weeks (66.6 vs 54.95, p=0.018).
When analyzed using composite SDOH scores and linear regression analysis controlling for other variables, a one percentage increase in Finance Status Score (worse financial status) corresponded to 0.91 increase in 6 week quickDASH score .
Additionally, a one percentage increase in Health Literacy Score correlated with an increased 3-month subjective pain rating (p=0.015) but a decrease in PROMIS Pain Medication Misuse score by 0.46.
Conclusion: Multiple social determinants of health may affect patient perceptions of pain and disability, and pain medication misuse. These findings may guide patient counseling and provision of supplemental resources for wrist fracture patients.
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