Social determinants of health – Neurosurgery Blog

Operative Neurosurgery 29:775–784, 2025

This systematic review examines the relationship between neighborhood-level socioeconomic disadvantage, measured by the Area Deprivation Index (ADI), and outcomes after various spine surgeries. Ten North American observational studies (56,925 patients) indicate higher ADI is associated with increased readmissions, emergency visits, longer lengths of stay, higher costs, and worse patient-reported outcomes for cervical and lumbar procedures.

The review outlines potential mechanisms—limited health literacy, barriers to follow-up, comorbidity control, and access deficits—and proposes targeted interventions across education, income/employment, housing, and household support to mitigate disparities and improve perioperative optimization and outcomes.

Area Deprivation Index (ADI): ADI is a validated, neighborhood-level measure of socioeconomic disadvantage, incorporating 17 variables across education, income/employment, housing, and household characteristics, with scores ranked from 0 (least disadvantaged) to 100 (most disadvantaged).

Association with Spine Surgery Outcomes: High ADI is linked to worse outcomes after spine surgery, including higher rates of postoperative readmissions, complications, emergency room visits, longer hospital stays, and poorer patient-reported outcomes (PROs).

Cervical Spine Surgery: Increased ADI is associated with higher costs of care, increased surgical utilization, and longer hospital length of stay after anterior cervical discectomy and fusion (ACDF); some studies also report increased likelihood of 30-day readmission, though not always statistically significant.

Lumbar Spine Surgery: High ADI predicts worse preoperative pain, function, depression, and anxiety scores; patients with high ADI experience greater rates of complications (e.g., respiratory failure), longer hospital stays, increased emergency visits, higher costs, and are less likely to achieve clinically meaningful improvements postoperatively.

Mechanisms of Disparity: Poor health literacy, reduced access to primary and follow-up care, barriers to transportation, and poor control of comorbidities are key mechanisms by which high ADI leads to worse surgical outcomes.

Potential Interventions: Targeted interventions addressing education (health literacy outreach, transitional care), income/employment (public assistance, nutrition programs), housing (medical-legal partnerships, transitional housing), and household resources (home health, internet access, transportation assistance) may help mitigate disparities for high ADI patients.

Limitations: Evidence is limited by heterogeneity of included studies, moderate risk of bias, small sample sizes for some subgroups, and lack of generalizability across all spine surgery types.

Future Directions: ADI can serve as a prognostic tool for identifying at-risk patients; further research should validate these associations and evaluate the effectiveness of targeted interventions to improve spine surgery outcomes in disadvantaged populations.

Neurosurgery 90:114–123, 2022

Meningiomas are the most common intracranial neoplasms. Although genomic analysis has helped elucidate differences in survival, there is evidence that racial disparities may influence outcomes. African Americans have a higher incidence of meningiomas and poorer survival outcomes. The etiology of these disparities remains unclear, but may include a combination of pathophysiology and other factors.

OBJECTIVE: To determine factors that contribute to different clinical outcomes in racial populations.

METHODS: We retrospectively reviewed 305 patients who underwent resection for meningiomas at a single tertiary care facility. We used descriptive statistics and univariate, multivariable, and Kaplan-Meier analyses to study clinical, radiographical, and histopathological differences.

RESULTS: Minority patients were more likely to present through the emergency department than an outpatient clinic (P < .0001). They were more likely to present with more advanced clinical symptoms with lower Karnofsky Performance scores, more frequently had peritumoral edema (P = .0031), and experienced longer postoperative stays in the hospital (P = .0053), and African-American patients had higher hospitalization costs (P = .046) and were more likely to be publicly insured. Extent of resection was an independent predictor of recurrence freedom (P = .039). Presentation in clinic setting trended toward an association with recurrence-free survival (P = .055). We observed no significant difference in gross total resection rates, postoperative recurrence, or recurrence-free survival.

CONCLUSION: Minority patients are more likely to present with severe symptoms, require longer perioperative hospitalization, and generate higher hospitalization costs. This may be due to socioeconomic factors that affect access to health care. Targeting barriers to access, especially to subspecialty care, may facilitate more appropriate and timely diagnosis, thereby improving patient care and outcomes.

Share this:

Like this:

Share this:

Like this: