Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
Semin Pediatr Surg. 2023 Dec;32(6):151354. doi: 10.1016/j.sempedsurg.2023.151354. Epub 2023 Nov 8.
There are notable inequities in health outcomes for children based on their social determinants of health (SDOH), including where they are born and live, their primary language, their race and ethnicity, socioeconomic status, and more. These health inequities are not restricted to resource limited settings; here we highlight three broad topics that are relevant to pediatric surgeons in the United States (US): access to care and disparities, and examples of inequities in firearm-related injuries and appendicitis. Most of our patients will at some point require operative interventions, yet there can be significant challenges in accessing this care and navigating our health systems, particularly around complex perioperative care. There are significant opportunities to improve equitable care by helping patients navigate our health systems and connecting them with additional resources, including screening for primary care services. Firearm-related injuries are now the leading cause of death in children in the US, with significant associated morbidity for non-fatal injuries. There are notable inequities in the risk of injury and types of injuries experienced by children based on their SDOH. Appendicitis is one of the most common pathologies managed by pediatric surgeons, with similar inequities in the rates of perforated appendicitis based on a child's SDOH. For both issues, addressing the inequities our patients experience requires moving upstream and working towards prevention. Key opportunities include better research and data to understand the drivers for observed inequities, multidisciplinary collaboration, community engagement, and public health advocacy among others. As a profession, we have a responsibility to work to address the health inequities our patients experience.
基于社会决定因素（SDOH），儿童的健康结果存在显著差异，包括他们出生和居住的地点、主要语言、种族和民族、社会经济地位等。这些健康不平等不仅限于资源有限的环境；在这里，我们强调三个与美国儿科医生相关的广泛主题：获得医疗保健的机会和差异，以及与枪支伤害和阑尾炎相关的不平等的例子。我们的大多数患者在某个时候都需要手术干预，但在获得这种护理和在我们的医疗系统中进行导航时，可能会面临重大挑战，尤其是在复杂的围手术期护理方面。通过帮助患者在我们的医疗系统中进行导航并为他们提供额外的资源，包括初级保健服务的筛查，为改善公平护理提供了重大机会。枪支伤害现在是美国儿童死亡的主要原因，非致命伤害的发病率也很高。基于社会决定因素，儿童受伤的风险和受伤类型存在显著差异。阑尾炎是儿科医生最常处理的一种病症，根据儿童的社会决定因素，阑尾炎穿孔的发病率也存在类似的不平等。对于这两个问题，要解决患者所经历的不平等问题，需要采取上游措施，努力预防。关键机会包括更好的研究和数据，以了解观察到的不平等现象的驱动因素，多学科合作、社区参与和公共卫生宣传等。作为一个专业，我们有责任努力解决患者所经历的健康不平等问题。
