Hernandez Alexandra H, Clark Nina M, Bisgaard Erika, Nehra Deepika, Stewart Barclay T, Malloy Alexander, Bulger Eileen M, Dieleman Joseph L, Zatzick Douglas, Scott John W
From the Department of Surgery (A.H.H., N.M.C., B.T.S.), Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery (E.B., D.N., B.T.S., A.M., E.M.B., J.W.S.), and Department of Health Metrics Sciences (J.L.D., J.W.S.), Institute for Health Metrics and Evaluation, University of Washington; Psychiatry and Behavioral Sciences (D.Z.), University of Washington School of Medicine, Seattle, Washington.
J Trauma Acute Care Surg. 2025 Feb 1;98(2):243-250. doi: 10.1097/TA.0000000000004508. Epub 2025 Jan 6.
Despite advances in trauma care, the effects of social determinants of health continue to be a barrier to optimal health outcomes. Health-related social needs (HRSNs), now the basis of a Centers for Medicare and Medicaid Services national screening program, may contribute to poor health outcomes, inequities, and low-value care, but the impact of HRSNs among injured patients remains poorly understood at the national level.
Using data from the nationally representative 2021 Medical Expenditure Panel Survey, injured patients were matched with uninjured controls via coarsened exact matching on age and sex. We then determined the prevalence of HRSNs based on core needs identified by Centers for Medicare and Medicaid Services: food, utilities, living situation, transportation, and personal safety. We used multivariable regression models to evaluate the association between HRSNs and health, delays in care, and emergency department visits.
Overall, 43% of injured patients reported one or more HRSNs. Compared with uninjured controls, injured patients were more likely to have unmet needs in all five HRSN domains (adjusted odds ratio, 1.44-2.00; p < 0.05 for all). In stratified analyses, HRSNs were highest among patients with lower income (65.1%), those who identified as Non-Hispanic Black patients (61.3%), and patients with Medicaid (66.1%). Increasing number of HRSNs was associated with worse physical and mental health ( p < 0.05). Injured patients with three or more HRSNs were also more likely to delay care because of cost (adjusted odds ratio, 3.79; 95% confidence interval, 2.29-6.27) and had greater emergency department utilization (adjusted incidence rate ratio, 1.47; 95% confidence interval, 1.16-1.87).
In this nationally representative study, nearly half of injured patients had one or more HRSNs. Greater numbers of HRSNs were associated with worse health outcomes, delayed care, and low-value care. As national screening for HRSNs is implemented, strategies to address these factors are needed and may serve to optimize health and health care utilization among injury survivors.
Prognostic and Epidemiological; Level III.
尽管创伤护理取得了进展，但健康的社会决定因素的影响仍然是实现最佳健康结果的障碍。与健康相关的社会需求（HRSNs），如今是医疗保险和医疗补助服务中心全国筛查计划的基础，可能会导致不良健康结果、不公平现象和低价值医疗，但在国家层面，HRSNs对受伤患者的影响仍知之甚少。
利用具有全国代表性的2021年医疗支出小组调查数据，通过年龄和性别的精确匹配，将受伤患者与未受伤的对照组进行匹配。然后，我们根据医疗保险和医疗补助服务中心确定的核心需求（食品、水电、居住状况、交通和个人安全）来确定HRSNs的患病率。我们使用多变量回归模型来评估HRSNs与健康、护理延迟和急诊就诊之间的关联。
总体而言，43%的受伤患者报告了一项或多项HRSNs。与未受伤的对照组相比，受伤患者在所有五个HRSN领域未满足需求的可能性更高（调整后的优势比为1.44 - 2.00；所有p值均<0.05）。在分层分析中，HRSNs在低收入患者（65.1%）、非西班牙裔黑人患者（61.3%）和医疗补助患者（66.1%）中最为常见。HRSNs数量的增加与身心健康状况较差相关（p<0.05）。有三项或更多HRSNs的受伤患者也更有可能因费用问题而延迟护理（调整后的优势比为3.79；95%置信区间为2.29 - 6.27），并且急诊利用率更高（调整后的发病率比为1.47；95%置信区间为1.16 - 1.87）。
在这项具有全国代表性的研究中，近一半的受伤患者有一项或多项HRSNs。更多的HRSNs与更差的健康结果、护理延迟和低价值医疗相关。随着全国范围内对HRSNs的筛查实施，需要制定应对这些因素的策略，这可能有助于优化受伤幸存者的健康和医疗服务利用。
预后和流行病学；三级。
