How social determinants of health negatively impact access to surgical care


Access to surgical care can play a significant role in a patient’s outcome, but many things can impact that access. One study takes a look.

Adequate access to appropriate surgical care reduces the risks of emergency surgical procedures, longer hospital stays, and higher costs of medical care. Patient-level social determinants of health have been shown to impact this access, but little research has been done about community-level determinants and pediatric surgery. An investigation used appendicitis, which is the most common cause for pediatric surgery, to look at what determinants were tied to access for pediatric surgical care.1

The investigators used the Pediatric Health Information System Database to find patients aged 18 years or younger who had an appendicitis diagnosis. The data was linked to the Childhood Opportunity Index 2.0 database, which examines multiple factors that indicate a zip code’s opportunity level, such as green spaces, toxin-free environments, and safety. The main outcome was the odds of presenting with a case of complicated appendicitis, based on the Childhood Opportunity Index level, and the secondary outcome was the odds of unplanned health care use after discharge, such as an emergency department visit, for patients with both simple and uncomplicated appendicitis.

In the cohort, 67,489 patients with an average age of 10.5 years had an appendicitis diagnosis, of which 31,223 were complicated. The majority of affected children were either non-Hispanic White (29,234) or Hispanic (24,234). Sixty percent were male and 47.9% had health care coverage though public insurance. The investigators found that the children who lived in neighborhoods that were very low on the Childhood Opportunity Index has 28% higher odds of having a complicated appendicitis diagnosis, when compared to children who lived in high Childhood Opportunity Index. No strong link between the Index level and unplanned health use after discharge was noted.

The investigators concluded that even after controlling for social determinants of health at the patient-level, that children who lived in neighborhoods with poorer social determinants of health were more likely to present with complicated appendicitis, which is often an indication of delayed access to care.


1. Bouchard M, Kan K, Tian Y, et al. Association between neighborhood-level social determinants of health and access to pediatric appendicitis care. JAMA Netw Open. 2022;5(2):e2148865. doi:10.1001/jamanetworkopen.2021.48865

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