Social Determinants of Health in Diverticulitis: A Systematic Review

Abstract

BACKGROUND: There is growing interest in social determinants of health for surgical populations. Within diverticulitis, no systematic collation of available evidence has been performed. OBJECTIVE: To assess frequency, variety, and association directions for social determinants of health in colonic diverticular disease. DATA SOURCES: Four electronic databases were queried: PubMed, Embase, Cochrane, and Web of Science. STUDY SELECTION: Included studies reported symptomatic left-sided colonic diverticular disease with respect to a social determinant of health according to the Healthy People 2030 initiative or applicable proxy variable. Studies with non-English full text, cohort size fewer than 50, pediatric cohorts, and exclusively non-left sided disease were excluded. MAIN OUTCOME MEASURES: Quality assessment through modified Newcastle-Ottawa scale, frequency of variables reported, and effect size trends for common comparisons. RESULTS: Among 50 included studies, 40 were good and 10 were fair in quality. Social determinants of health in diverticulitis were identified across Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context domains. The two most common variables were self-reported race and ethnicity (n = 33) and insurance (n = 22). Among 18 unique studies reporting comparisons of white versus any other self-reported race and ethnicity, twelve identified a disparity disadvantaging non-white groups with effect sizes (95% confidence interval ranging from 1.23 [1.10 -1.37] to 5.35 [1.32 - 21.61]). Among 15 unique studies reporting a non-private versus private insurance comparison, nine identified non-private insurance as a risk factor with effect sizes (95% confidence intervals ranging from 1.15 [1.02 – 1.29] to 3.83 [3.01 – 4.87]). LIMITATIONS: Retrospective studies, heterogeneity across cohort and variable definitions. CONCLUSIONS: Social determinants of health domains are associated with a variety of diverticulitis outcomes. Additional studies are needed to address infrequently reported domains and identify optimal strategies for intervening in clinical settings. PROSPERO ID: CRD42023422606