SOCIAL DETERMINANTS OF HEALTH IN TRAUMA: A PRELIMINARY STUDY

Objectives: The term “social determinants” refers to a variety of environmental factors that can influence certain clinical outcomes such as morbidity and mortality. Examples of social determinants include tobacco and alcohol use, intimate partner violence, socioeconomic status, and food insecurity. The present study seeks to determine if any of these social determinants may affect outcomes in trauma patients. We hypothesized that patients with an “at risk” classification for any of the social determinants will have a greater frequency of negative outcomes when compared to their “not at risk” counterparts.

Methods: A retrospective review was performed of all trauma patients admitted to our Level-1 Trauma Center from January 1, 2021 to February 28, 2022 with information regarding at least one social determinant were included for analysis in this study. Patient data was collected from the hospital’s trauma registry, and electronic medical records. For each social determinant, patients were reported as “at risk” or “not at risk” based on information listed in electronic medical records. Patients were excluded if they had no recorded social determinants of health in the medical record. Univariate analysis was conducted using one-way ANOVA and Chi-squared tests.

Results: 2,225 trauma patients met the inclusion criteria. If social determinants had at least a 60% collection rate they were included. Tobacco use, stress, and intimate partner violence met this criteria. Characteristics of at risk and not at risk patients are in Table 1. Tobacco usage was the only social determinant that was significantly associated with 30-day mortality with 8.89% of at risk individuals having a 30-day mortality opposed to 6.23% in their not at risk counterparts (p=0.029). Social determinants with more than 40% missing data were not included due to lack of reporting. This applied to alcohol use, food insecurity, transport needs, physical activity, social connections, depression, and housing stability.

Conclusion: While the goal of this study was to assess the effects of high-risk social determinants on outcomes in trauma patients, the findings demonstrate a paucity of data in electronic medical records regarding a patient’s social determinants. In an effort to provide more inclusive care and address health disparities in our patient population, there is a need for more complete data collection upon admission/duration of hospital stay. This information would be invaluable in delivering high-quality patient care, as understanding a patient’s high-risk social determinant(s) could help clinicians guide patients towards the necessary resources to ameliorate these risks.