Purpose
Social determinants of health (SDOH) are the collection of environmental, institutional and intrinsic conditions that may bias access to, and utilization of, healthcare across an individual’s lifetime. The effects of SDOH are associated with disparities in outcomes after hip and knee arthroplasty, but its impact on rotator cuff repair (RCR) is poorly understood. This study aimed to investigate the influences SDOH have on accessing appropriate orthopaedic treatment, as well as its effects on outcomes following RCR.
Methods
This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration. A search of PubMed, Cochrane Library, and Embase from inception until March 2022 was conducted to identify studies reporting at least one SDOH and its effect on healthcare access, clinical outcomes, or patient-reported outcomes following RCR. The search term was created with reference to the PROGRESS-Plus framework. Methodological quality of included studies was appraised using the Newcastle-Ottawa Scale for non-randomized studies, and the Cochrane Risk of Bias Tool for randomized studies.
Results
Thirty-two studies (level I-IV evidence) from 18 journals across 7 countries, published between 1999 and 2022, met inclusion criteria, including 102,372 patients, 669 physical therapy clinics, and 71 orthopaedic surgery practices. Multivariate analysis revealed female gender, labor-intensive occupation, comorbidities, tobacco use, federally-subsidized insurance, lower education level, racial/ethnic minority status, low-income place of residence and low-volume surgery regions, unemployment, and preoperative narcotic use contribute to delays in access to healthcare and/or more severe disease state upon presentation.
Conclusion
The impediments created by SDOH lead to worse outcomes following RCR including increased risk of postoperative complications, failed repair, higher rates of revision surgery, and decreased ability to return to work. Orthopaedic surgeons, policy makers, and insurers should be aware of the aforementioned SDOH as markers for characteristics that may predispose to inferior outcomes following RCR.