Bergmark Regan W, Sedaghat Ahmad R
Department of Otolaryngology Massachusetts Eye and Ear Infirmary.
Department of Otolaryngology Harvard Medical School Boston Massachusetts U.S.A.
Laryngoscope Investig Otolaryngol. 2017 May 28;2(4):187-193. doi: 10.1002/lio2.81. eCollection 2017 Aug.
Social determinants of health include social and demographic factors such as poverty, education status, race and ethnicity, gender, insurance status, and other factors that influence (1) development of illness, (2) ability to obtain and utilize healthcare, and (3) health and healthcare outcomes. In otolaryngology, as in other subspecialty surgical fields, we are constantly confronted by patients' social and demographic circumstances including poverty, language barriers, and lack of health insurance and yet there is limited research on how these factors impact health equity in our field, or how attention to these patient characteristics may improve health equity. This review provides the reader with a framework to understand the social determinants of health including how socioeconomic status, insurance status, race, gender, and other factors impact health.
Foundational papers on the social determinants of health are reviewed, as well as otolaryngology publications focused on health and healthcare disparities.
The social determinants of health have a major impact on patient health as well as healthcare utilization, but there is a relative lack of data on these factors and how they can be addressed within otolaryngology. Incorporating tools to measure social and demographic characteristics and actually report on these measures is a first simple step to increase the data on the social determinants of health as they pertain to otolaryngology.
More research is needed on the social determinants of health, and how they impact otolaryngic disease. Medicare's Accountable Care Organization models will increasingly change the way in which physicians are reimbursed, making the social determinants of health central not only to our moral conscience but also the bottom line.
健康的社会决定因素包括社会和人口因素，如贫困、教育状况、种族和民族、性别、保险状况以及其他影响以下方面的因素：（1）疾病的发生；（2）获得和利用医疗保健的能力；（3）健康状况和医疗保健结果。与其他专科手术领域一样，在耳鼻喉科，我们经常面对患者的社会和人口状况，包括贫困、语言障碍以及缺乏医疗保险。然而，关于这些因素如何影响我们领域的健康公平性，或者关注这些患者特征如何改善健康公平性的研究却很有限。本综述为读者提供了一个框架，以理解健康的社会决定因素，包括社会经济地位、保险状况、种族、性别和其他因素如何影响健康。
对关于健康社会决定因素的基础论文以及专注于健康和医疗保健差异的耳鼻喉科出版物进行了综述。
健康的社会决定因素对患者健康以及医疗保健利用有重大影响，但关于这些因素以及如何在耳鼻喉科中解决这些因素的数据相对较少。纳入测量社会和人口特征的工具并实际报告这些指标是增加与耳鼻喉科相关的健康社会决定因素数据的第一步简单措施。
需要对健康的社会决定因素及其如何影响耳鼻喉科疾病进行更多研究。医疗保险的 accountable care organization 模式将越来越多地改变医生的报销方式，使健康的社会决定因素不仅成为我们道德良知的核心，也成为底线。
4 级。
