The impact of social determinants of health on shoulder instability and likelihood of surgery: a systematic review
Notice bibliographique
Résumé
Background: Arthroscopic Bankart repair following shoulder dislocation results in a lower rate of recurrence and faster return to play when compared to nonoperative treatment in patients with first-time shoulder dislocations. The purpose of this study was to determine if specific social determinants of health are associated with a decreased likelihood of undergoing arthroscopic Bankart repair in patients with shoulder instability. Methods: A literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Web of Science, and Embase. Two independent reviewers performed an assessment of the resulting 334 studies, and 23 were selected for full-text review. Inclusion criteria consisted of peer-reviewed journal articles published in the United States from 2010 to present. Publications that were not peer-reviewed (eg, conference abstracts, podium presentations, and commentaries) and systematic reviews were excluded. Covidence was used for data extraction. Risk of bias assessment was performed on the final studies using the Newcastle-Ottawa scale, AXIS tool, and Quality of Health Economic Studies instrument. All studies were designated as high quality or met >80% criteria for low risk of bias. Results: Nine studies across 5 journals met inclusion criteria, evaluating a total of 43,054 patients with shoulder instability. Among the 7 studies that included a gender breakdown, 18,350 (42.6%) of patients were female. There were 5 cohort studies (56%), 2 cross-sectional studies (22%), 1 survey study (11%), and 1 economic and decision analysis (11%). Six studies (67%) evaluated insurance status, 6 (67%) evaluated race and ethnicity, and 3 (33%) evaluated income status. Three studies (33%) included other factors such as social deprivation index and distressed community index. Black race and Hispanic ethnicity, public insurance, lower income quartile, and increased social deprivation were associated with lower rates of arthroscopic Bankart repair. Higher surgical costs were associated with public insurance and below-median income. Patients with public insurance had longer wait times between injury presentation and surgery. Conclusions: Minority race or ethnicity, public insurance status, lower income, and increased social deprivation were found to decrease accessibility and reduce the likelihood of undergoing Bankart repair in patients with shoulder instability. In addition, public insurance was associated with longer wait times between injury presentation and surgery. A delay in treatment for patients with shoulder instability may increase the risk of recurrent instability and the development of additional intra-articular pathology, which can, in turn, lead to worse clinical outcomes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,010 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».