The Impact of Social Determinants of Health on Pressure Ulcer Prognosis: A Retrospective Chart and Systematic Review
Daniel C. Sasson, Kaiti Duan, Seema M. Patel, Alexandra Junn, Henry C. Hsia
Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
Background We aimed to understand the effects of SDOH on pressure ulcer prognosis, focusing on nutritional security, through a rigorous review of the literature and retrospective review of pressure ulcer patients reporting to a single hospital system. Methods A literature review was performed for full-text, original articles reporting outcomes data specific to the prevalence of pressure ulcers in patients with evidence of socially-informed nutritional insecurity. Subsequent to identifying zero eligible studies, a retrospective review of all patients from 2012-2021 was performed, searching for those with pressure ulcer documentation and ICD-10 Z codes related to the SDOH. Results 2323 articles from 1965-2020 resulted from the literature review. Full-text review failed to locate any eligible studies. 1044 patients were identified for analysis. 50.7% were male, 74.3% were white, and 13.3% had evidence of detrimental SDOH. The average duration of disease for all incidents for all patients was 12.13 days (IQR 6). Multivariate regression analysis revealed that males, Blacks / African Americans, or patients with evidence of detrimental SDOH suffer from pressure ulcers for a longer average duration than their converse counterparts (p < 0.0001, Table 1). The presence of detrimental SDOH independently predicted an increased average disease duration by 13.07 days (95% CI = 8.99 to 17.15, |t| = 6.29, p < 0.0001). BMI was not a significant predictor of the average duration of disease (p = 0.62). Conclusions A significant relationship was shown between a patient’s SDOH history and their pressure ulcer prognosis. Further, a patient’s SDOH history had a considerably stronger correlation with disease prognosis than traditionally-analyzed predictors such as sex, race, or BMI. Our retrospective chart review’s findings are novel and the first to demonstrate the effects of SDOH on pressure ulcer prognosis, as highlighted by the lack of data uncovered in the literature. Future investigations would benefit from the inclusion of a broader patient cohort, as well as an examination into the confounding effects of diabetes and tobacco use on pressure ulcer prognosis. Additionally, the inclusion of patient income quartile (based on zip code of residence) could provide information complementary to this study.
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