Walker Rebekah J, Smalls Brittany L, Campbell Jennifer A, Strom Williams Joni L, Egede Leonard E
Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN Ralph H. Johnson VAMC, Charleston, SC, USA.
Endocrine. 2014 Sep;47(1):29-48. doi: 10.1007/s12020-014-0195-0. Epub 2014 Feb 15.
Social determinants of health include the social and economic conditions that influence health status. Research into the impact of social determinants on individuals with type 2 diabetes has largely focused on the prevention of or risk of developing diabetes. No review exists summarizing the impact of social determinants of health outcomes in patients with type 2 diabetes. This systematic review examined whether social determinants of health have an impact on health outcomes in type 2 diabetes. Medline was searched for articles that (a) were published in English (b) targeted adults, ages 18 + years, (c) had a study population which was diagnosed with type 2 diabetes, (d) the study was done in the United States, and (e) the study measured at least one of the outcome measures-glycemic control, cholesterol (LDL), blood pressure, quality of life or cost. Using a reproducible strategy, 2,110 articles were identified, and 61 were reviewed based on inclusion criteria. Twelve were categorized as Economic Stability and Education, 17 were categorized as Social and Community Context, 28 were categorized as Health and Health Care, and three were categorized as Neighborhood and Built Environment. Based on the studies reviewed, social determinants have an impact on glycemic control, LDL, and blood pressure to varying degrees. The impact on cost and quality of life was not often measured, but when quality of life was investigated, it did show significance. More research is needed to better characterize the direct impact of social determinants of health on health outcomes in diabetes.
健康的社会决定因素包括影响健康状况的社会和经济条件。对社会决定因素对2型糖尿病患者影响的研究主要集中在糖尿病的预防或发病风险上。目前尚无综述总结健康的社会决定因素对2型糖尿病患者健康结局的影响。本系统综述探讨了健康的社会决定因素是否对2型糖尿病的健康结局有影响。在Medline数据库中检索符合以下条件的文章：（a）以英文发表；（b）针对18岁及以上的成年人；（c）研究人群被诊断为2型糖尿病；（d）研究在美国进行；（e）研究至少测量了以下一项结局指标——血糖控制、胆固醇（低密度脂蛋白）、血压、生活质量或成本。采用可重复的策略，共识别出2110篇文章，并根据纳入标准对61篇进行了综述。其中12篇归类为经济稳定性和教育，17篇归类为社会和社区背景，28篇归类为健康与医疗保健，3篇归类为邻里和建成环境。基于所综述的研究，社会决定因素对血糖控制、低密度脂蛋白和血压有不同程度的影响。对成本和生活质量的影响较少被测量，但在调查生活质量时，确实显示出显著性。需要更多的研究来更好地描述健康的社会决定因素对糖尿病健康结局的直接影响。
