Social Determinants of Health: A Critical Factor in Adult Traumatic Brachial Plexus Injury Outcomes

INTRODUCTION: Over the past three decades, there has been an accumulation of evidence pointing to social determinants of health (SDOH) as inherent causes for an array of health outcomes. METHODS: Between January 2010—June 2019, a retrospective analysis was performed using PearlDiver’s Mariner. One-to-one exact-matching based on baseline patient demographics was completed, creating three identical groups: AT-BPI disparity cohort: patients with AT-BPI and presence of at least one SDOH disparity prior to injury: • economic instability • food insecurity • inadequate education • community and social context problems • inaccessible healthcare facilities • neighborhood and physical environment issues AT-BPI without disparity cohort: patients with AT-BPI and the absence of any SDOH disparity. Control cohort: patients without AT-BPIs. The following primary psychosocial outcomes were included in our study: depression, anxiety, drug abuse, alcohol abuse, suicide attempt, post-traumatic stress disorder, and divorce. RESULTS: The matched population analyzed in this study consisted of 1,176 patients that were equally represented in the AT-BPI disparity cohort (n = 392, 33.33%), AT-BPI without disparity cohort (n = 392, 33.33%), and control cohort (n = 392, 33.33%). A total of 301 patients developed any psychosocial condition with four-years of their injury. Patients in the AT-BPI disparity cohort had significantly higher rates of developing any psychosocial condition (31.12%, p < 0.0005), depression (22.70%, p = 0.0032), anxiety (18.62%, p = 0.0203), drug abuse (7.91%, p = 0.0060), and alcohol abuse (4.85%, p = 0.03499) when compared to the other cohorts. Furthermore, the disparity cohort carried a significantly increased risk of developing any psychosocial condition (HR 1.42, 95% CI 1.09-1.86). The rates of suicide attempt, post-traumatic stress disorder, and divorce did not significantly differ between groups. CONCLUSION: AT-BPI patients with SDOH disparities are at increased risk of developing new-onset psychosocial conditions, such as depression, anxiety, drug abuse, and alcohol abuse. Clinicians should routinely screen for psychiatric conditions and assess social factors to improve identification of at-risk patients. A multidisciplinary approach incorporating medical, surgical, social, and psychological experts should be considered when managing these injuries.