Tackling health inequalities: socio-demographic data could play a bigger role

Tarrant, Carolyn; Wobi, Fatimah; Angell, Emma

doi:10.1093/fampra/cmt071

Cited by 7 publications

(11 citation statements)

References 3 publications

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“…[79, 83, 84, 86–88] For example, Moser and colleagues have suggested that ‘the routine collection within general practice of additional sociodemographic information would aid monitoring of inequalities in screening coverage and inform policies to correct them.’ [84] Similarly, preventative strategies, including childhood immunisations, might be better resourced and targeted because these activities ‘are known to reach those in poor socioeconomic circumstances less well’. [35, 92] Socioeconomic data could then be used to direct service provision toward ‘areas of highest need’. [90, 91, 93] The data could also enable healthcare providers to better understand the particular needs of populations and adapt services to meet those needs.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Moscrop

Ziébland

Roberts

et al. 2019

Int J Equity Health

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Background People’s social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients’ socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients’ socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not , be enquired about. Methods Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a ‘snowball’ search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients’ socioeconomic information; ‘screening’ patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients’ healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. ‘Reason data’ was extracted from eligible publications by two authors, then analysed and organised. Results We identified 138 eligible publications. Most offered reasons for why patients’ should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary. Conclusions This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.

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Section: Resultsmentioning

confidence: 99%

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Moscrop

Ziébland

Roberts

et al. 2019

Int J Equity Health

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“…Sociodemographic factors are associated with inequalities in mortality, morbidity, and functional status 16 - 19 and may help to explain the variation in outcomes following TKR. Evidence on the effect of sociodemographic factors on the outcomes of TKR is conflicting.…”

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confidence: 99%

The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes

Edwards

Smith

Herrett

et al. 2018

JBJS OA

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Background:Total knee replacement (TKR) is a common procedure for the treatment of osteoarthritis that provides a substantial reduction of knee pain and improved function in most patients. We investigated whether sociodemographic factors could explain variations in the benefit resulting from TKR.Methods:Data were collected from 3 sources: the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man; National Health Service (NHS) England Patient Reported Outcome Measures; and Hospital Episode Statistics. These 3 sources were linked for analysis. Pain and function of the knee were measured with use of the Oxford Knee Score (OKS). The risk factors of interest were age group, sex, deprivation, and social support. The outcomes of interest were sociodemographic differences in preoperative scores, 6-month postoperative scores, and change in scores.Results:Ninety-one thousand nine hundred and thirty-six adults underwent primary TKR for the treatment of osteoarthritis in an NHS England unit from 2009 to 2012. Sixty-six thousand seven hundred and sixty-nine of those patients had complete knee score data and were included in the analyses for the present study. The preoperative knee scores were worst in female patients, younger patients, and patients from deprived areas. At 6 months postoperatively, the mean knee score had improved by 15.2 points. There were small sociodemographic differences in the benefit of surgery, with greater area deprivation (−0.71 per quintile of increase in deprivation; 95% confidence interval [CI], −0.76 to −0.66; p < 0.001) and younger age group (−3.51 for ≤50 years compared with 66 to 75 years; 95% CI, −4.00 to −3.02; p < 0.001) associated with less benefit. Cumulatively, sociodemographic factors explained <1% of the total variability in improvement.Conclusions:Sociodemographic factors have a small influence on the benefit resulting from TKR. However, as they are associated with the clinical threshold at which the procedure is performed, they do affect the eventual outcomes of TKR.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of evidence.

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“…Health‐care providers reported similar concerns with the collection of sociodemographic information as patients. The studies that assessed health‐care providers’ opinions on potential harms focused on race/ethnicity/culture/language; it is likely that the same concerns apply for the collection of religion and income data . Health‐care providers may not be fully prepared to ask their patients about sociodemographic information and to address patient concerns with this data collection.…”

Section: Discussionmentioning

confidence: 99%

Potential harms associated with routine collection of patient sociodemographic information: A rapid review

Petkovic

Duench

Welch

et al. 2018

Health Expectations

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BackgroundHealth systems are recommended to capture routine patient sociodemographic data as a key step in providing equitable person‐centred care. However, collection of this information has the potential to cause harm, especially for vulnerable or potentially disadvantaged patients.ObjectiveTo identify harms perceived or experienced by patients, their families, or health‐care providers from collection of sociodemographic information during routine health‐care visits and to identify best practices for when, by whom and how to collect this information.Search StrategyWe searched OVID MEDLINE, PubMed “related articles” via NLM and healthevidence.org to the end of January 2018 and assessed reference lists and related citations of included studies.Inclusion CriteriaWe included studies reporting on harms of collecting patient sociodemographic information in health‐care settings.Data Extraction and SynthesisData on study characteristics and types of harms were extracted and summarized narratively.Main ResultsEighteen studies were included; 13 provided patient perceptions or experiences with the collection of these data and seven studies reported on provider perceptions. Five reported on patient recommendations for collecting sociodemographic information. Patients and providers reported similar potential harms which were grouped into the following themes: altered behaviour which may affect care‐seeking, data misuse or privacy concerns, discomfort, discrimination, offence or negative reactions, and quality of care. Patients suggested that sociodemographic information be collected face to face by a physician.Discussion and ConclusionsOverall, patients support the collection of sociodemographic information. However, harms are possible, especially for some population subgroups. Harms may be mitigated by providing a rationale for the collection of this information.

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Tackling health inequalities: socio-demographic data could play a bigger role

Cited by 7 publications

References 3 publications

A systematic review of reasons for and against asking patients about their socioeconomic contexts

A systematic review of reasons for and against asking patients about their socioeconomic contexts

The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes

Potential harms associated with routine collection of patient sociodemographic information: A rapid review

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