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"Social determinants of health"
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Contextual nonmedical health factors and critical care-related outcomes: a systematic review
Background
Disparities in non-medical health factors, such as social determinants of health (SDoH), are associated with increased risk of negative health outcomes. Leveraging contextual (or area-based) measures of SDoH is essential for uncovering broader factors influencing disparities in critical care-related outcomes. Our objective is to review evidence analyzing the association between contextual SDoH obtained from publicly available databases and critical care-related outcomes in the United States (US).
Methods
We conducted searches in the Web of Science, PubMed, Cochrane, and Embase electronic database to obtain clinical studies utilizing SDoH datasets from publicly available data sources and analyzed these studies for associations between critical care-related outcomes and SDoH (search date June 8th, 2025). We excluded non-English articles, reviews, editorial commentaries, letters to editors, studies without intensive care unit (ICU) patients or SDoH variables, studies based on countries outside of the US and studies that lacked full text or contained only the abstract. We extracted cohort characteristics, SDoH measures and domains, SDOH database characteristics, ICU admissions and outcomes, analytical method used for determining the association between SDoH and ICU variables, and significant SDoH variables.
Results
We identified 87 publications (44 with pediatric patients, 40 with adult patients, and 3 with a mixture of both) and study population characteristics (e.g., surgical or specific disease-diagnosed patients). Child Opportunity Index and American Community Survey were the top platforms utilized for acquiring SDoH in pediatric and adult cohorts, respectively, followed by Area Deprivation Index and Social Vulnerability Index in both cohort types. Area-level granularity included boundaries determined by counties, ZIP codes, census block groups and census tracts.
Conclusions
Among five SDoH domains, economic stability was found to be the top investigated SDoH category for critical care-related outcomes. Contextual SDoH variables, indicating more vulnerable and adverse conditions, were associated with higher ICU admissions, greater need for ICU resource utilization, longer ICU duration, higher likelihood of developing critical illnesses, worsened life quality following ICU discharge, and higher mortality. Social determinants of health offer a broad area for modifiable intervention targets. Public databases serve as facilitators towards SDoH integration into electronic health records, promoting value-based care and mitigating health inequities.
Journal Article
Financial health as a measurable social determinant of health
Financial health, understood as one's ability to manage expenses, prepare for and recover from financial shocks, have minimal debt, and ability to build wealth, underlies all facets of daily living such as securing food and paying for housing, yet there is inconsistency in measurement and definition of this critical concept. Most social determinants research and interventions focus on siloed solutions (housing, food, utilities) rather than on a root solution such as financial health. In light of the paucity of public health research on financial health, particularly among low-income populations, this study seeks to: 1) introduce the construct of financial health into the domain of public health as a useful root term that underlies other individual measures of economic hardship and 2) demonstrate through outcomes on financial, physical and mental health among low-income caregivers of young children that the construct of financial health belongs in the canon of social determinants of health.
In order to extract features of financial health relevant to overall well-being, principal components analysis were used to assess survey data on banking and personal finances among caregivers of young children who participate in public assistance. Then, a series of logistic regressions were utilized to examine the relationship between components of financial health, depression and self-rated health.
Components aligned with other measures of financial health in the literature, and there were strong associations between financial health and health outcomes.
Financial health can be conceived of and measured as a key social determinant of health.
Journal Article
Journal Voices in the Civil Rights Era — New Horizons and Limits in Medical Publishing
During the social tumult of the 1960s and 1970s, the
Journal
opened its pages to advocates of reform in the profession and society at large, but it did not completely break with its troubled racial past.
Journal Article
Epidemic exposure : the rich flee and the poor take the bus
\"This work provides a look at health and economic inequality in pandemics\"-- Provided by publisher.
Book
How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa
Background
The current Coronavirus disease pandemic reveals political and structural inequities of the world’s poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania.
Methods
We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences.
Results
Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals.
Conclusion
Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in ‘normal’ circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.
Journal Article
Disparities in health-related quality of life in women undergoing treatment for advanced ovarian cancer: the role of individual-level and contextual social determinants
PurposeSocial determinants may influence health-related quality of life (HRQOL) among women with ovarian cancer, potentially creating disparities in clinical outcomes. We investigated the relationship between HRQOL and social determinants of health, including travel distance to access cancer care and health insurance type, among women participating in a randomized trial of primary adjuvant treatment for advanced ovarian cancer.MethodsThe Functional Assessment of Cancer Therapy-Ovarian (FACT-O) questionnaire captured HRQOL (physical well-being, functional well-being, ovarian-specific, and trial outcome index [TOI]) prior to chemotherapy (baseline), during the trial, and 84 weeks after initiation of chemotherapy for women with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer. We constructed bivariate and multivariable linear mixed effects models examining the associations of social determinants of health (individual-level and contextual factors) with HRQOL scores at 84 weeks, clustering participants (n = 993) within treatment centers, and Census regions and controlling for baseline HRQOL.ResultsMost individual-level (race, age, cancer stage, adverse events) and contextual (travel distance to treatment center, community socioeconomic status) factors were not statistically significantly associated with HRQOL. Compared to participants with private health insurance, other participants had lower mean HRQOL (physical well-being: public insurance, − 1.00 (standard error[SE] = 0.49) points, uninsured, − 1.93 (SE = 0.63) points; functional well-being: public, − 1.29 (SE = 0.59), uninsured, − 1.98 (SE = 0.76); ovarian cancer-specific: public, − 1.60 (SE = 0.59), uninsured, − 1.66 (SE = 0.75); TOI: public, − 3.81 (SE = 1.46), uninsured, − 5.51 (SE = 1.86); all p < .05).ConclusionsPrivate health insurance was associated with improved HRQOL at the completion of treatment for advanced stage ovarian cancer. Implications of health insurance on HRQOL should be further investigated, particularly among women with ovarian cancer who receive standard of care treatment.
Journal Article