Disparities in health in the United States: An overview of the social determinants of health for otolaryngologists

Abstract

ObjectivesSocial determinants of health include social and demographic factors such as poverty, education status, race and ethnicity, gender, insurance status, and other factors that influence (1) development of illness, (2) ability to obtain and utilize healthcare, and (3) health and healthcare outcomes. In otolaryngology, as in other subspecialty surgical fields, we are constantly confronted by patients’ social and demographic circumstances including poverty, language barriers, and lack of health insurance and yet there is limited research on how these factors impact health equity in our field, or how attention to these patient characteristics may improve health equity. This review provides the reader with a framework to understand the social determinants of health including how socioeconomic status, insurance status, race, gender, and other factors impact health.Data Sources and Review MethodsFoundational papers on the social determinants of health are reviewed, as well as otolaryngology publications focused on health and healthcare disparities.ResultsThe social determinants of health have a major impact on patient health as well as healthcare utilization, but there is a relative lack of data on these factors and how they can be addressed within otolaryngology. Incorporating tools to measure social and demographic characteristics and actually report on these measures is a first simple step to increase the data on the social determinants of health as they pertain to otolaryngology.ConclusionMore research is needed on the social determinants of health, and how they impact otolaryngic disease. Medicare's Accountable Care Organization models will increasingly change the way in which physicians are reimbursed, making the social determinants of health central not only to our moral conscience but also the bottom line.Level of Evidence4

The impact of social determinants of health on laryngotracheal stenosis development and outcomes

“…Social determinants of health is an umbrella term used to describe the demographic and socioeconomic factors within a patient's environment that contribute to disease development, management, and outcomes . The study of these social determinants, such as income, education, race, nutrition, and insurance is gaining momentum as a promising method to decrease the burden of disease and achieve health equity .…”

“…Social determinants of health is an umbrella term used to describe the demographic and socioeconomic factors within a patient's environment that contribute to disease development, management, and outcomes . The study of these social determinants, such as income, education, race, nutrition, and insurance is gaining momentum as a promising method to decrease the burden of disease and achieve health equity . Disparities in these factors have been documented in multiple otolaryngologic diseases, and several studies have employed zip code–based analysis to describe sociodemographic factors as well as geographic clustering of patients .…”

“…1 The study of these social determinants, such as income, education, race, nutrition, and insurance is gaining momentum as a promising method to decrease the burden of disease and achieve health equity. 1,2 Disparities in these factors have been documented in multiple otolaryngologic diseases, 1,[3][4][5] and several studies have employed zip code-based analysis to describe sociodemographic factors as well as geographic clustering of patients. [5][6][7] A recent study utilizing zip code-based analysis demonstrated higher sociodemographic status patients have higher utilization rates for chronic rhinosinusitis treatment.…”

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

“…Disparities based on the social determinants of health have been studied across medicine. [15][16][17][18][19][20][21][22][23][24][26][27][28][29][30][31][32] Within otolaryngology, differences between patients with private and public insurance have been described in several settings including acute rhinosinusitis, 21 head and neck cancer, [22][23][24] otolaryngology surgery generally, 25 and septorhinoplasty. 26 However, there is a dearth of literature on disparities in patient-reported outcomes and surgical approaches to functional rhinoplasty.…”

“…15 Some important social determinants of health include socioeconomic status, insurance status and health care access, race and ethnicity, gender, and language. 16 Lower socioeconomic status and minority race have been associated with poorer health outcomes including higher mortality rate. 17,18 Lower socioeconomic status is also associated with a lower utilization of health care across medicine, ranging from mammograms to influenza vaccinations.…”