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Quantifying the collective influence of social determinants of health using conditional and cluster modeling.

Publication ,  Journal Article
Rethorn, ZD; Garcia, AN; Cook, CE; Gottfried, ON
Published in: PLoS One
2020

OBJECTIVES: Our objective was to analyze the collective effect of social determinants of health (SDoH) on lumbar spine surgery outcomes utilizing two different statistical methods of combining variables. METHODS: This observational study analyzed data from the Quality Outcomes Database, a nationwide United States spine registry. Race/ethnicity, educational attainment, employment status, insurance payer, and gender were predictors of interest. We built two models to assess the collective influence of SDoH on outcomes following lumbar spine surgery-a stepwise model using each number of SDoH conditions present (0 of 5, 1 of 5, 2 of 5, etc) and a clustered subgroup model. Logistic regression analyses adjusted for age, multimorbidity, surgical indication, type of lumbar spine surgery, and surgical approach were performed to identify the odds of failing to demonstrate clinically meaningful improvements in disability, back pain, leg pain, quality of life, and patient satisfaction at 3- and 12-months following lumbar spine surgery. RESULTS: Stepwise modeling outperformed individual SDoH when 4 of 5 SDoH were present. Cluster modeling revealed 4 distinct subgroups. Disparities between the younger, minority, lower socioeconomic status and the younger, white, higher socioeconomic status subgroups were substantially wider compared to individual SDoH. DISCUSSION: Collective and cluster modeling of SDoH better predicted failure to demonstrate clinically meaningful improvements than individual SDoH in this cohort. Viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDoH on outcomes.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2020

Volume

15

Issue

11

Start / End Page

e0241868

Location

United States

Related Subject Headings

  • White People
  • United States
  • Treatment Outcome
  • Socioeconomic Factors
  • Social Determinants of Health
  • Retrospective Studies
  • Quality of Life
  • Models, Statistical
  • Minority Groups
  • Middle Aged
 

Citation

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Rethorn, Z. D., Garcia, A. N., Cook, C. E., & Gottfried, O. N. (2020). Quantifying the collective influence of social determinants of health using conditional and cluster modeling. PLoS One, 15(11), e0241868. https://doi.org/10.1371/journal.pone.0241868
Rethorn, Zachary D., Alessandra N. Garcia, Chad E. Cook, and Oren N. Gottfried. “Quantifying the collective influence of social determinants of health using conditional and cluster modeling.PLoS One 15, no. 11 (2020): e0241868. https://doi.org/10.1371/journal.pone.0241868.
Rethorn ZD, Garcia AN, Cook CE, Gottfried ON. Quantifying the collective influence of social determinants of health using conditional and cluster modeling. PLoS One. 2020;15(11):e0241868.
Rethorn, Zachary D., et al. “Quantifying the collective influence of social determinants of health using conditional and cluster modeling.PLoS One, vol. 15, no. 11, 2020, p. e0241868. Pubmed, doi:10.1371/journal.pone.0241868.
Rethorn ZD, Garcia AN, Cook CE, Gottfried ON. Quantifying the collective influence of social determinants of health using conditional and cluster modeling. PLoS One. 2020;15(11):e0241868.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2020

Volume

15

Issue

11

Start / End Page

e0241868

Location

United States

Related Subject Headings

  • White People
  • United States
  • Treatment Outcome
  • Socioeconomic Factors
  • Social Determinants of Health
  • Retrospective Studies
  • Quality of Life
  • Models, Statistical
  • Minority Groups
  • Middle Aged