The Impact of Education Level, Access to Transportation, and the Home Environment on Patient-Reported Outcomes after Orthopaedic Trauma Surgery

Abstract

Objectives It is known that Social Determinants of Health (SDOH) impact a variety of health outcomes. Of these determinants, it remains unclear how education level, access to transportation, and the home environment influence Patient-Reported Outcomes (PROs) following orthopaedic trauma surgery. Methods A cross-sectional survey was conducted at an urban level 1 trauma center to collect data on demographics, education level, access to transportation, and the home environment of 120 patients who underwent fracture fixation surgery. Patient data was correlated with PRO data as measured by Patient Reported Outcomes Measurement Information System (PROMIS) survey scores, including global mental health (GM), global physical health (GP), pain interference (PI), and physical function (PF). A multivariable mixed-effects regression analysis was performed to determine associations between SDOH and PROs. Results Multivariable regression analysis results demonstrated that patients with high school or lower education levels were associated with better PF (P=0.007). Patients with access to transportation were associated with higher GM (P = 0.016), while those who lived greater than 5 miles from the hospital were associated with higher GP (P = 0.0498). Those with difficulty accessing the bathroom were associated with lower GP (P = 0.007) and GM (P = 0.0008), increased PI (P = 0.0002), and lower PF (P = 0.004). People living in apartments had higher GM (P = 0.0008). Navigating stairs inside the home was associated with lower GP (P = 0.030) and higher PI (P = 0.0007), while those who navigated stairs outside of their home reported higher GP (P = 0.038). Conclusion This study found that in our population, education level, access to transportation, and the home environment appeared to be associated with PROs following orthopaedic trauma surgery.