The use of key social determinants of health variables in psychiatric research using routinely collected health data: a systematic analysis

Mediation of Latinx health status disparities during the COVID-19 pandemic by social determinants of health

PURPOSE

The hypothesis that health status disparities exist because of high levels of social disadvantages, the Social Determinants of Health - Health Disparities (SDOH-HD) hypothesis by Ramírez García [1], was investigated among adults (N = 1,833) attending SARS-CoV-2 testing events at 71 community sites.

METHODS

A Multilevel Structural Equation Model (CFI = 1.0, SRMRs ≤ 0.03), with cross-sectional self-reported data, operationalized health status with latent individual level and latent community site level variables. At the individual level, health variables met full or partial metric equivalence between participants who answered the survey in Spanish versus in English (CFIs = 0.99, SRMRs ≤ 0.03).

RESULTS

Consistent with the SDOH-HD, high food insecurity and/or low levels of education among Latinxs putatively mediated (abs = 0.01 to 0.08, ps < 0.05) worse individual level general health (Within Level Model R2 = 0.10, p <.05) or worse individual level psychological distress (Within Level Model R2 = 0.11, p <.05) compared to non-Latinx Whites. However, three SDOH - unemployment, housing instability, and discrimination - did not support the SDOH-HD. Community site level SDOH - social vulnerability, and minority status indices - were not significantly related to site level health status, but site level psychological distress was lower in rural than in urban sites (γ = - 0.39, p <.05).

CONCLUSION

Taken together, the results delineate that equitable implementation of food security and education interventions may mitigate health status Latinx disparities. The SDOH-HD was partially supported, underscoring the need to investigate further these and additional SDOH-HD pathways.

Longitudinal analysis of lifetime stressors and depression: Exploring intersectionality and tailoring social support for better mental health in a community population cohort

AIMS

Health inequalities studies need to understand how individuals simultaneously defined by several socioeconomic factors differ from others when facing a series of stressors across the lifespan in the risk of major depression (MD). Theoretical efforts, as well as empirical studies, have suggested a pertinent role of social support in mental health outcomes. However, little is known about which forms of social support would alleviate the negative impact of MD vulnerability in self-rated mental health (SRMH) across different socioeconomic groups. We investigated 1) differential associations between lifetime stressors and MD across social groups and 2) explored diverse social support forms mediating the associations between MD vulnerability and SRMH.

METHODS

Data analyzed were from a large longitudinal population-based cohort. Multilevel analysis of individual heterogeneity and discriminatory accuracy was used to articulate MD vulnerability in different social groups defined by ethnicity, gender, and socioeconomic status (SES). Genetic predispositions were also included in the modeling process. These social groups were then regrouped based on their vulnerability level of MD. Mediation analyses were then applied to identify which social support forms mediate the effect of MD vulnerability on SRMH.

RESULTS

Higher levels of stressors were associated with higher risks of MD, and their associations varied by different social groups. The social groups (White men with medium SES or White women with high SES) had the lowest predicted incidence of MD, whereas White women with low SES reported the highest predicted incidence of MD. Two social support forms (guidance and opportunity for nurturance) significantly mediated the indirect paths between MD vulnerability and SRMH.

CONCLUSIONS

By applying an intersectional lens, the present study provides a novel quantitative instrument for documenting the associations of stress and depression in various social identities. The findings of the study suggest more focused intervention programs and strategies for risk reduction should focus on identified characteristics and pay particular attention to the combined effect of lifetime stressors and discovered social identities.

Operationalising routinely collected patient data in research to further the pursuit of social justice and health equity: a team-based scoping review

BACKGROUND

Vast volumes of routinely collected data (RCD) about patients are collated by health professionals. Leveraging this data - a form of real-world data - can be valuable for quality improvement and contributing to the evidence-base to inform practice. Examining routine data may be especially useful for examining issues related to social justice such as health inequities. However, little is known about the extent to which RCD is utilised in health fields and published for wider dissemination.

OBJECTIVES

The objective of this scoping review is to document the peer-reviewed published research in allied health fields which utilise RCD and evaluate the extent to which these studies have addressed issues pertaining to social justice.

METHODS

An enhanced version of the Arksey and O'Malley's framework, put forth by Westphalm et al. guided the scoping review. A comprehensive literature search of three databases identified 1584 articles. Application of inclusion and exclusion criteria was piloted on 5% of the papers by three researchers. All titles and abstracts were screened independently by 2 team members, as were full texts. A data charting framework, developed to address the research questions, was piloted by three researchers with data extraction being completed by the lead researcher. A sample of papers were independently charted by a second researcher for reliability checking.

RESULTS

One hundred and ninety papers were included in the review. The literature was diverse in terms of the professions that were represented: physiotherapy (33.7%) and psychology/mental health professions (15.8%) predominated. Many studies were first authored by clinicians (44.2%), often with clinical-academic teams. Some (33.25%) directly referenced the use of their studies to examine translation of research to practice. Few studies (14.2%) specifically tackled issues pertaining to social justice, though many collected variables that could have been utilised for this purpose.

CONCLUSION

Studies operationalising RCD can meaningfully address research to practice gaps and provide new evidence about issues related to social justice. However, RCD is underutilised for these purposes. Given that vast volumes of relevant data are routinely collected, more needs to be done to leverage it, which would be supported by greater acknowledgement of the value of RCD studies.

Reporting of equity in observational epidemiology: A methodological review

Background

Observational studies can inform how we understand and address persisting health inequities through the collection, reporting and analysis of health equity factors. However, the extent to which the analysis and reporting of equity-relevant aspects in observational research are generally unknown. Thus, we aimed to systematically evaluate how equity-relevant observational studies reported equity considerations in the study design and analyses.

Methods

We searched MEDLINE for health equity-relevant observational studies from January 2020 to March 2022, resulting in 16 828 articles. We randomly selected 320 studies, ensuring a balance in focus on populations experiencing inequities, country income settings, and coronavirus disease 2019 (COVID-19) topic. We extracted information on study design and analysis methods.

Results

The bulk of the studies were conducted in North America (n = 95, 30%), followed by Europe and Central Asia (n = 55, 17%). Half of the studies (n = 171, 53%) addressed general health and well-being, while 49 (15%) focused on mental health conditions. Two-thirds of the studies (n = 220, 69%) were cross-sectional. Eight (3%) engaged with populations experiencing inequities, while 22 (29%) adapted recruitment methods to reach these populations. Further, 67 studies (21%) examined interaction effects primarily related to race or ethnicity (48%). Two-thirds of the studies (72%) adjusted for characteristics associated with inequities, and 18 studies (6%) used flow diagrams to depict how populations experiencing inequities progressed throughout the studies.

Conclusions

Despite over 80% of the equity-focused observational studies providing a rationale for a focus on health equity, reporting of study design features relevant to health equity ranged from 0-95%, with over half of the items reported by less than one-quarter of studies. This methodological study is a baseline assessment to inform the development of an equity-focussed reporting guideline for observational studies as an extension of the well-known Strengthening Reporting of Observational Studies in Epidemiology (STROBE) guideline.