University of Chicago, Pritzker School of Medicine, Chicago, IL.
University of Chicago, Pritzker School of Medicine, Chicago, IL.
J Hand Surg Am. 2023 Nov;48(11):1128-1138. doi: 10.1016/j.jhsa.2023.08.005. Epub 2023 Sep 28.
Social determinants of health (SDOH) are linked to poor health care outcomes across the different medical specialties. We conducted a scoping review to understand the existing literature and identify further areas of research to address disparities within hand surgery.
A systematic search of PubMed, Scopus, and Cochrane was conducted. Inclusion criteria were English studies examining health disparities in hand surgery. The following were assessed: the main SDOH, study design/phase/theme, and main disease/injury/procedure. A previously described health disparities research framework was used to determine study phase: detecting (identifying risk factors), understanding (analyzing risk factors), and reducing (assessing interventions). Studies were categorized according to themes outlined at the National Institute of Health and American College of Surgeons: Summit on Surgical Disparities.
The initial search yielded 446 articles, with 49 articles included in final analysis. The majority were detecting-type (31/49, 63%) or understanding-type (12/49, 24%) studies, with few reducing-type studies (6/49, 12%). Patient factors (31/49, 63%) and systemic/access factors (16/49, 33%) were the most frequently studied themes, with few investigating clinical care/quality factors (4/49, 8%), clinician factors (3/49, 6%), and postoperative/rehabilitation factors (1/49, 2%). The most commonly studied SDOH include insurance status (13/49, 27%), health literacy (10/49, 20%), and social deprivation (6/49, 12%). Carpal tunnel syndrome (9/49, 18%), upper extremity trauma (9/49, 18%), and amputations (5/49, 10%) were frequently assessed. Most investigations involved retrospective or database designs (29/49, 59%), while few were prospective, cross-sectional, or mixed-methods.
Despite an encouraging upward trend in health disparities research, existing studies are in the early phases of investigation.
Most of the literature focuses on patient factors and systemic/access factors in regard to insurance status. Further work with prospective, cross-sectional, and mixed-method studies is needed to better understand health disparities in hand surgery, which will inform future interventions.
健康的社会决定因素（SDOH）与不同医学专业的医疗保健结果不佳有关。我们进行了一项范围界定审查，以了解现有文献并确定进一步研究领域，以解决手外科领域的差异。
对 PubMed、Scopus 和 Cochrane 进行了系统检索。纳入标准为研究手外科健康差异的英文研究。评估的内容包括主要的 SDOH、研究设计/阶段/主题和主要疾病/损伤/程序。使用先前描述的健康差异研究框架来确定研究阶段：检测（确定危险因素）、理解（分析危险因素）和减少（评估干预措施）。根据美国国立卫生研究院和美国外科医师学院概述的主题对研究进行分类：外科差异峰会。
最初的搜索产生了 446 篇文章，其中 49 篇文章被纳入最终分析。大多数是检测型（31/49，63%）或理解型（12/49，24%）研究，而减少型研究较少（6/49，12%）。患者因素（31/49，63%）和系统/获取因素（16/49，33%）是最常研究的主题，很少有研究涉及临床护理/质量因素（4/49，8%）、临床医生因素（3/49，6%）和术后/康复因素（1/49，2%）。最常研究的 SDOH 包括保险状况（13/49，27%）、健康素养（10/49，20%）和社会贫困（6/49，12%）。腕管综合征（9/49，18%）、上肢创伤（9/49，18%）和截肢（5/49，10%）经常被评估。大多数调查涉及回顾性或数据库设计（29/49，59%），而前瞻性、横断面或混合方法的研究较少。
尽管健康差异研究呈上升趋势，但现有研究仍处于早期调查阶段。
大多数文献主要关注与保险状况相关的患者因素和系统/获取因素。需要进一步开展前瞻性、横断面和混合方法的研究，以更好地了解手外科中的健康差异，从而为未来的干预措施提供信息。
