The Assessment of Social Determinants of Health in Postsepsis Mortality and Readmission: A Scoping Review.
The Assessment of Social Determinants of Health in Postsepsis Mortality and Readmission: A Scoping Review.
复制标题
脓毒症后死亡率和再入院健康社会决定因素的评估：范围界定审查。
DOI：
10.1097/cce.0000000000000722
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发表时间：
2022
影响因子：
--
通讯作者：
Taylor,Stephanie
中科院分区：
文献类型：
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作者：
Hilton,RyanS;Hauschildt,Katrina;Shah,Milan;Kowalkowski,Marc;Taylor,Stephanie
目的：总结关于健康社会决定因素（SDH）与脓毒症后结局之间关系的知识并确定证据差距。数据来源：我们对PubMed/Medical Literature Analysis and Retrieval System Online、abstrpta Medica数据库和Cochrane Library进行了全面的检索。研究选择：我们选取了评价SDH为败血症住院后死亡率或再入院危险因素的文章。两位作者独立筛选并选择纳入的文章。数据提取：我们双重提取研究特征，特别关注SDH变量的测量、报告和解释。数据综合：在筛选的2077篇文章中，103篇文章评估了败血症后死亡率或再入院的危险因素。其中28例（27%）包含至少一个SDH变量。随着时间的推移，SDH被纳入评估脓毒症后不良后果的研究。最常见的SDH评估是种族/民族（n= 21, 75%），其次是付款人类型（n= 10, 36%）和收入/财富（n= 9, 32%）。在包括种族/民族的研究中，9项（32%）未评估其他SDH。只有一项包括种族/民族的研究讨论了使用这个变量作为社会劣势的替代，没有一项研究专门讨论了结构性种族主义。没有一项研究专门讨论了验证SDH准确性或处理缺失数据的方法。8项（29%）研究包含了数据丢失不常见的一般性陈述。几项研究报告了SDH与脓毒症出院后预后之间的独立关联；然而，这些发现在不同的研究中是混合的。结论：我们的综述表明，在评估脓毒症后不良事件的研究中，SDH数据未得到充分利用，且质量不确定。迫切需要透明和明确的SDH数据的个体发生和数据模型来支持研究和临床应用，特别关注促进我们对种族主义和种族健康不平等在败血症后结局中的作用的理解。
OBJECTIVE:To summarize knowledge and identify gaps in evidence about the relationship between social determinants of health (SDH) and postsepsis outcomes.DATA SOURCES:We conducted a comprehensive search of PubMed/Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, and the Cochrane Library.STUDY SELECTION:We identified articles that evaluated SDH as risk factors for mortality or readmission after sepsis hospitalization. Two authors independently screened and selected articles for inclusion.DATA EXTRACTION:We dual-extracted study characteristics with specific focus on measurement, reporting, and interpretation of SDH variables.DATA SYNTHESIS:Of 2,077 articles screened, 103 articles assessed risk factors for postsepsis mortality or readmission. Of these, 28 (27%) included at least one SDH variable. Inclusion of SDH in studies assessing postsepsis adverse outcomes increased over time. The most common SDH evaluated was race/ethnicity (n= 21, 75%), followed by payer type (n= 10, 36%), and income/wealth (n= 9, 32%). Of the studies including race/ethnicity, nine (32%) evaluated no other SDH. Only one study including race/ethnicity discussed the use of this variable as a surrogate for social disadvantage, and none specifically discussed structural racism. None of the studies specifically addressed methods to validate the accuracy of SDH or handling of missing data. Eight (29%) studies included a general statement that missing data were infrequent. Several studies reported independent associations between SDH and outcomes after sepsis discharge; however, these findings were mixed across studies.CONCLUSIONS:Our review suggests that SDH data are underutilized and of uncertain quality in studies evaluating postsepsis adverse events. Transparent and explicit ontogenesis and data models for SDH data are urgently needed to support research and clinical applications with specific attention to advancing our understanding of the role racism and racial health inequities in postsepsis outcomes.