Wright Melissa A, Beleckas Casey M, Calfee Ryan P
Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.
St. Louis, MO.
J Hand Surg Am. 2019 Apr;44(4):335.e1-335.e9. doi: 10.1016/j.jhsa.2018.05.019. Epub 2018 Jun 23.
Social, mental, and physical health have a complex interrelationship with each influencing individuals' overall health experience. Social circumstances have been shown to influence symptom intensity and magnitude of disability for a variety of medical conditions. We tested the null hypothesis that social deprivation would not impact Patient-Reported Outcomes Measurement Information System (PROMIS) scores or objective health factors in patients presenting for treatment of carpal tunnel syndrome (CTS).
This cross-sectional study analyzed data from 367 patients who presented for evaluation of CTS to 1 of 6 hand surgeons at a tertiary academic center between August 1, 2016, and June 30, 2017. Patients completed PROMIS Physical Function-v1.2, Pain Interference-v1.1, Depression-v1.0, and Anxiety-v1.0 Computer Adaptive Tests. The Area Deprivation Index was used to quantify social deprivation. Medical record review determined duration of symptoms, tobacco and opioid use, and the Charlson Comorbidity Index (CCI) for each patient. Sample demographics, PROMIS scores, and objective health measures were compared in groups defined by national quartiles of social deprivation.
Patients with CTS living in the most deprived quartile had worse mean scores across all 4 PROMIS domains compared with those living in the least deprived quartile. A higher proportion of individuals from the most deprived quartile had a heightened level of anxiety than those in the least deprived quartile (37.3% vs 12.6%). The mean CCI was higher in the most deprived quartile, as was the proportion of individuals using tobacco. There were no differences in opioid use or symptom duration between patients from each deprivation quartile.
Social deprivation is associated with worse patient-reported health measures in patients with CTS. Compared with those from the least deprived areas, patients from the most deprived areas also have a greater comorbidity burden and higher rates of tobacco use at presentation to a hand surgeon.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
社会、心理和身体健康之间存在复杂的相互关系，它们都会影响个体的整体健康体验。研究表明，社会环境会影响多种医疗状况下的症状强度和残疾程度。我们检验了以下零假设：社会剥夺不会影响前来治疗腕管综合征（CTS）患者的患者报告结局测量信息系统（PROMIS）评分或客观健康因素。
这项横断面研究分析了2016年8月1日至2017年6月30日期间在一家三级学术中心向6位手外科医生之一就诊以评估CTS的367例患者的数据。患者完成了PROMIS身体功能 - v1.2、疼痛干扰 - v1.1、抑郁 - v1.0和焦虑 - v1.0计算机自适应测试。采用地区剥夺指数来量化社会剥夺程度。通过病历审查确定每位患者的症状持续时间、烟草和阿片类药物使用情况以及查尔森合并症指数（CCI）。在根据社会剥夺程度的全国四分位数定义的组中比较样本人口统计学、PROMIS评分和客观健康指标。
与生活在最不贫困四分位数的患者相比，生活在最贫困四分位数的CTS患者在所有4个PROMIS领域的平均得分都更低。最贫困四分位数的个体中焦虑水平较高的比例高于最不贫困四分位数的个体（37.3%对12.6%）。最贫困四分位数的平均CCI更高，使用烟草的个体比例也是如此。各剥夺四分位数的患者在阿片类药物使用或症状持续时间方面没有差异。
社会剥夺与CTS患者报告的较差健康指标相关。与来自最不贫困地区的患者相比，来自最贫困地区的患者在就诊于手外科医生时也有更大的合并症负担和更高的烟草使用率。
研究类型/证据水平：预后性II级。
