University of California, San Francisco, San Francisco, CA.
Icahn School of Medicine at Mount Sinai, New York, NY.
Hepatology. 2021 Nov;74(5):2824-2830. doi: 10.1002/hep.32073. Epub 2021 Oct 4.
The social determinants of health, defined as the conditions in which we live, learn, work, and play, undoubtedly impact health outcomes. Social adversity in childhood perpetuates over the life course and has consequences extending into adulthood. This link between social adversity and adverse outcomes extends to children undergoing liver transplant, with children from socioeconomically deprived neighborhoods experiencing a greater burden of morbidity and mortality after transplant. Yet, we lack an in-depth understanding of how to address social adversity for these children. Herein, we lay out a strategy to develop and test interventions to address social adversity for children undergoing liver transplant. To do so, we believe that more granular data on how specific social risk factors (e.g., food insecurity) impact outcomes for children after liver transplant are needed. This will provide the liver transplant community with knowledge on the most pressing problems. Then, using the National Academies of Sciences, Engineering, and Medicine's framework for integrating social needs into medical care, the health system can start to develop and test health system interventions. We believe that attending to our patients' social adversity will realize improved outcomes for children undergoing liver transplant.
健康的社会决定因素，定义为我们生活、学习、工作和娱乐的条件，无疑会影响健康结果。儿童时期的社会逆境会持续整个生命周期，并对成年后的健康产生影响。这种社会逆境与不良结果之间的联系也延伸到了正在接受肝移植的儿童身上，来自社会经济贫困社区的儿童在接受肝移植后，发病率和死亡率更高。然而，我们缺乏深入了解如何为这些儿童解决社会逆境的方法。在此，我们提出了一项制定和测试干预措施的策略，以解决正在接受肝移植的儿童的社会逆境问题。为此，我们认为需要更多关于特定社会风险因素（例如，粮食不安全）如何影响肝移植后儿童预后的具体数据。这将为肝移植界提供最紧迫问题的相关知识。然后，利用美国国家科学院、工程院和医学院的将社会需求纳入医疗保健的框架，医疗系统可以开始制定和测试医疗系统干预措施。我们相信，关注患者的社会逆境将为接受肝移植的儿童带来更好的预后。
