R. A. Heng1, B. Smith1, L. Wood1, B. Brock1, C. Hodges1, B. Jones2, W. Oslock1, N. English3, R. Hollis1, D. Gunnells1, D. Chu1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2University Of Texas Southwestern Medical Center, Department Of Surgery, Dallas, TX, USA 3University of Cape Town, Department Of General Surgery, Cape Town, WC, South Africa
Introduction:
Social determinants of health (SDOHs) play an important role in surgical disparities. However, variations in these SDOHs among racial groups undergoing elective colorectal surgery have not been comprehensively explored. The aim of the study is to identify differences in SDOHs between Black and White patients undergoing elective colorectal surgery. Social factors such as trust, social support, and discrimination are hypothesized to differ by race and may partially mediate racial disparities in colorectal surgery outcomes.
Methods:
This was a retrospective study of prospectively collected data of elective colorectal surgery patients from 8/2021 to 7/2023 at a single academic medical center. Prior to the start of the study, an 88-item survey was developed using a modified Delphi method assessing 24 different SDOHs at all 5 socioecological levels. Consenting participants completed the survey in a clinical setting on an electronic tablet within 14 days of surgery. The primary outcomes were the measured SDOHs. Comparisons were made by race/ethnicity to determine modifiable SDOHs to target for future disparity reducing interventions.
Results:
The cohort consisted of 262 patients with a median age of 59.6 years (IQR 49.1-67.9), of which 47% were male and 30% were Black. Statistically significant differences were observed between White and Black patients in several SDOH domains. Notably, Black participants exhibited lower Patient Activation Measure (PAM) scores (42 vs 47, p=0.005), indicating diminished knowledge, skills, and confidence in managing their own health and healthcare. Additionally, Community Involvement (WVS) scores were higher among Black patients (3 vs 2, p=0.013), reflecting increased active participation in organizations or groups such as community service, advocacy groups, political groups, sports groups, or church. Discrimination scores were notably higher for Black participants (12 vs 0, p=0.005), underscoring a more frequent experience of lesser courtesy, respect, or poorer service compared to others in daily life. Furthermore, Black patients had higher scores in the Neighborhood Healthy Foods (NAF) domain (8 vs 6, p=0.009), which indicates reduced access to healthy food environments, including low-fat products, fruits, and vegetables. These SDOHs are potentially contributing to racial disparities in surgery.
Conclusion:
SDOHs are measurable by validated instruments and vary in a surgical population. Black patients were more likely to report reduced access to healthy foods, discrimination, and diminished confidence in managing their own healthcare compared to White patients undergoing elective colorectal surgery. Further investigation should be performed to determine if these determinants are independently associated with surgical outcomes.