Department of Pediatrics, Harvard Medical School, Boston, MA.
Department of Cardiology, Boston Children's Hospital, Boston, MA.
Crit Care Med. 2023 Jul 1;51(7):843-860. doi: 10.1097/CCM.0000000000005866. Epub 2023 Mar 28.
To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes.
PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population).
Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support.
Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool.
Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors.
Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.
绘制社会决定因素（SDoH）与体外膜氧合（ECMO）利用或结果之间关联的范围、方法严谨性、质量和方向。
系统检索了 2000 年 1 月至 2023 年 1 月期间的 PubMed、Web of Science、Embase 和 Cochrane 图书馆数据库，以检查社会经济地位（SES）、种族、族裔、医院和 ECMO 计划特征、运输以及地理位置（背景）与 ECMO 患者（人群）的利用和结果（概念）之间的关系。
方法遵循系统评价和荟萃分析扩展的首选报告项目范围审查。两名审查员独立评估了确定出版物的摘要和全文。排除标准包括非英语、不可用、少于 40 名患者以及围手术期或混合机械支持。
内容分析使用标准化的数据提取工具和作者提出的差异调节因素的归纳主题分析。使用预后研究质量工具评估偏倚风险。
在筛选的 8214 条引文中，确定了 219 项研究。主要分析重点是 148 项（68%），包括种族/族裔/SES/付款人变量，包括调查 ECMO 结果 114 项（77%）和利用 43 项（29%）。在 15 项（10%）中，SDoH 是主要预测因素。根据种族、族裔、SES 或付款人，ECMO 结果或利用的关联方向差异很大。在 38%的情况下，在代表性不足、资源不足或多样化的人群中报告了不良结果或使用率较低，而在这些人群中观察到了改善的结果或更高的使用率，分别为 7%和 55%，没有统计学意义。只有 26 项研究（18%）讨论了差异的机制驱动因素，主要集中在个体和医院层面，而不是系统/结构因素。
ECMO 利用和结果与 SDoH 之间的关联不一致，受到人群异质性和分析缺陷的影响，对系统性因素的考虑有限。这些发现和研究差距对 ECMO 研究和医疗保健中 SDoH 的测量、分析和解释具有影响。
