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Bridging the Gap: Assessing the Reporting of Social Determinants of Health Across a Decade of Craniofacial Reconstruction Trials
Daniel Y. Kwon
*1, Henry Diamond-Pott
1, Minwoo Kwon
1, Katherine G. Stark
1, Rachel A. Klem
2, Mateo Restrepo Mejia
1, Peter J. Taub
11Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; 2Lewis Katz School of Medicine, Temple University, Philadelphia, PA
Background: Social determinants of health (SDOH) play a critical role in shaping patient outcomes across medical and surgical disciplines. The present study sought to evaluate SDOH reporting in randomized controlled trials (RCTs) of craniofacial surgery over the past decade.
Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematics and Meta-Analyses (PRISMA) statement guidelines. The PubMed and SCOPUS databases were queried for manuscripts based on RCTs published from 2014-2024. Manuscripts focusing primarily on craniofacial reconstruction, published in English, involving participants ≥18 years old, with reported outcomes related to surgical interventions were included. The frequency of SDOH variables reported either solely within the manuscript or within the manuscript and its tables were noted. Chi-square and Fisher's exact tests were performed, and Pearson correlation coefficients were calculated (p<0.05).
Results: A total of 150 trials were included. Age (95.3%), sex/gender (70.0%), and BMI/weight (25.3%) were the most reported variables. All other SDOH variables were reported less than 10% of the time. Age, sex/gender, and language proficiency were significantly less likely to be reported in tables (p<0.05). Trials of US origin were not significantly more likely to report any SDOH measure than non-US trials. No significant correlation was observed between year of publication and proportion of trials reporting SDOH variables (R=0.28, p=0.40. There was also no significant correlation between impact factor and proportion of trials reporting SDOH variables (R=0.58, p=0.31).
Conclusion: Despite the well-established impact of SDOH on health outcomes, our findings highlight a persistent underreporting of these factors in craniofacial reconstruction trials. Future RCTs should prioritize the standardized inclusion of SDOH variables to enhance the generalizability of findings and inform more equitable surgical care.
Reporting of Social Determinants of Health in Randomized Controlled Trials in Craniofacial Reconstruction, 2014-2024
| Variables | Anywhere in Manuscript (%) | In Tables (%) | p-Value |
| Age | 143 (95.3%) | 96 (64.0%) | <0.001 |
| Sex/Gender | 105 (70.0%) | 72 (48.0%) | <0.001 |
| BMI/Weight | 38 (25.3%) | 32 (21.3%) | 0.495 |
| Race/Ethnicity | 9 (6.0%) | 3 (2.0%) | 0.138 |
| Education Level | 6 (4.0%) | 4 (2.7%) | 0.75 |
| Insurance | 1 (0.7%) | 0 (0.0%) | 1 |
| Smoking/Tobacco Use | 6 (4.0%) | 3 (2.0%) | 0.501 |
| Socioeconomic Status | 3 (2.0%) | 1 (0.7%) | 0.622 |
| Marital Status | 0 (0.0%) | 0 (0.0%) | 1 |
| Alcohol Use | 1 (0.7%) | 0 (0.0%) | 1 |
| Language Proficiency | 6 (4.0%) | 0 (0.0%) | 0.03 |
| Geographic Measures | 0 (0.0%) | 0 (0.0%) | 1 |
| Employment | 5 (3.3%) | 4 (2.7%) | 1 |
| Housing/Residence Status | 0 (0.0%) | 0 (0.0%) | 1 |
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