Advani Sonali D, Smith Alison G, Kalu Ibukunoluwa C, Perez Reinaldo, Hendren Stephanie, Dantes Raymund B, Edwards Jonathan R, Soe Minn, Yi Sarah H, Young Janine, Anderson Deverick J
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA.
Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Antimicrob Steward Healthc Epidemiol. 2024 Sep 23;4(1):e139. doi: 10.1017/ash.2024.397. eCollection 2024.
The field of healthcare epidemiology is increasingly focused on identifying, characterizing, and addressing social determinants of health (SDOH) to address inequities in healthcare quality. To identify evidence gaps, we examined recent systematic reviews examining the association of race, ethnicity, and SDOH with inpatient quality measures.
We searched Medline via OVID for English language systematic reviews from 2010 to 2022 addressing race, ethnicity, or SDOH domains and inpatient quality measures in adults using specific topic questions. We imported all citations to Covidence (www.covidence.org, Veritas Health Innovation) and removed duplicates. Two blinded reviewers assessed all articles for inclusion in 2 phases: title/abstract, then full-text review. Discrepancies were resolved by a third reviewer.
Of 472 systematic reviews identified, 39 were included. Of these, 23 examined all-cause mortality; 6 examined 30-day readmission rates; 4 examined length of stay, 4 examined falls, 2 examined surgical site infections (SSIs) and one review examined risk of venous thromboembolism. The most evaluated SDOH measures were sex (n = 9), income and/or employment status (n = 9), age (n = 6), race and ethnicity (n = 6), and education (n = 5). No systematic reviews assessed medication use errors or healthcare-associated infections. We found very limited assessment of other SDOH measures such as economic stability, neighborhood, and health system access.
A limited number of systematic reviews have examined the association of race, ethnicity and SDOH measures with inpatient quality measures, and existing reviews highlight wide variability in reporting. Future systematic evaluations of SDOH measures are needed to better understand the relationships with inpatient quality measures.
医疗保健流行病学领域越来越关注识别、描述和解决健康的社会决定因素（SDOH），以解决医疗质量方面的不平等问题。为了识别证据差距，我们审查了最近的系统评价，这些评价考察了种族、民族和SDOH与住院患者质量指标之间的关联。
我们通过OVID在Medline中检索2010年至2022年期间使用特定主题问题探讨种族、民族或SDOH领域以及成人住院患者质量指标的英文系统评价。我们将所有引文导入Covidence（www.covidence.org，Veritas Health Innovation）并去除重复项。两名盲法评审员分两个阶段评估所有文章是否纳入：标题/摘要，然后是全文评审。分歧由第三位评审员解决。
在识别出的472篇系统评价中，纳入了39篇。其中，23篇考察了全因死亡率；6篇考察了30天再入院率；4篇考察了住院时间，4篇考察了跌倒情况，2篇考察了手术部位感染（SSIs），1篇综述考察了静脉血栓栓塞风险。评估最多的SDOH指标是性别（n = 9）、收入和/或就业状况（n = 9）、年龄（n = 6）、种族和民族（n = 6）以及教育程度（n = 5）。没有系统评价评估用药错误或医疗相关感染。我们发现对其他SDOH指标（如经济稳定性、社区和卫生系统可及性）的评估非常有限。
仅有少数系统评价考察了种族、民族和SDOH指标与住院患者质量指标之间的关联，现有综述突出了报告中的广泛差异。需要对SDOH指标进行未来的系统评估，以更好地理解其与住院患者质量指标之间的关系。
