Review Looks at Impact of SDOH on Bleeding Disorders

A recent review examined the impact of social determinants of health (SDOH) on health outcomes for individuals with inherited bleeding disorders, such as hemophilia A, hemophilia B, von Willebrand disease, and others.

More than 3 million Americans have such disorders, and social determinants play a role in a number of ways, including cost for treatment, difficulty accessing specialists, educational barriers, and more.

The authors used PubMed to search for articles published in English between 2011 and 2021. Inclusion criteria included studies in which 1 of the following clinical outcomes were measured: bleeding frequency, chronic pain, mortality, quality of life, and/or cost of treatment, in a population diagnosed with an inherited bleeding disorder. In addition, results were restricted to free text articles.

The search resulted in 1466 original articles, and 13 articles were chosen for the analysis. Articles were categorized by categories of SDOH: health care system, economic stability, neighborhood/physical environment, community/social context, education, and food.

Several of the 13 articles overlapped multiple areas: 3 were categorized as economic stability, 1 was categorized as neighborhood and physical environment, 2 were categorized as education, 12 were categorized as community and social context, and 4 were categorized as health care systems. None fell into the food category.

The following themes were identified from the reports, which included case studies, literature reviews, and cross-sectional studies:

• Economic—studies reported a large burden of costs, missed or foregone work or school opportunities, and chronic pain.
• Neighborhoods—1 study analyzed patients in a rural area of Canada, who felt that their location both delayed diagnosis and reduced their access to care.
• Education—work/school absences could last for as long as 293 days, but this could be reduced with prophylactic treatment and also managed with psychosocial education.
• Community/social—this category examined quality of life issues and sports participation. While several studies noted that bleeding episodes rose with increased activity, it was also linked to better quality of life. Other findings of some of the studies were more mixed; for example, some sports participants seemed to have lower pain and some had higher.

The analysis had several limitations, including the fact that the search was limited to free full-text English articles due to funding issues, and so there may be publication bias. The SDOH category of food was not analyzed in the results. Finally, most studies were observational designs.

The authors called for additional research, including studies that delve more deeply into specific areas of SDOH impact, such as food and neighborhoods.

Reference

Lopez K, Norris K, Hardy M, Valentino L. Defining the impact of social drivers on health outcomes for people with inherited bleeding disorders. J Clin Med. Published online July 30, 2022. doi:10.3390/jcm11154443