The impact of social determinants of health on shoulder instability and likelihood of surgery: a systematic review
Bibliographic record
Abstract
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 Publications that were not peer-reviewed (eg, conference abstracts, podium presentations, and commentaries) and systematic reviews were excluded.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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.045 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.012 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".