Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct;40(19-20):1977-1989.
doi: 10.1089/neu.2023.0021. Epub 2023 Jun 9.

Social Determinants of Health and Health Equity in the Diagnosis and Management of Pediatric Mild Traumatic Brain Injury: A Content Analysis of Research Underlying Clinical Guidelines

Nathan E Cook  1   2   3 , Alicia Kissinger-Knox  1   3 , Ila A Iverson  4 , Brian C Liu  2   3 , Charles E Gaudet  1   2   3 , Marc A Norman  5 , Grant L Iverson  1   2   3   6
Affiliations

Social Determinants of Health and Health Equity in the Diagnosis and Management of Pediatric Mild Traumatic Brain Injury: A Content Analysis of Research Underlying Clinical Guidelines

Nathan E Cook et al. J Neurotrauma. 2023 Oct.

Abstract

We conducted a content analysis of the literature underlying the Centers for Disease Control and Prevention (CDC) Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children (i.e., the "Guideline") to determine the extent to which social determinants of health (SDoH) were examined or addressed. The systematic review forming the basis for the Guideline included 37 studies addressing diagnosis, prognosis, and treatment/rehabilitation. We examined those studies to identify SDoH domains derived from the U.S. Department of Health and Human Services' Healthy People 2020 and 2030 websites. No study explicitly mentioned "social determinants of health," by name, and few studies addressed SDoH domains as a primary focus (ranging from 0% to 27% of studies across SDoH domains). The most frequently represented SDoH domains, described in an inferential or a descriptive manner, were Education Access and Quality (29.7% of studies), Social and Community Context (27.0% of studies), and Economic Stability (21.6% of studies). Health Care Access (13.5% of studies) was less well represented and no studies (0%) examined Neighborhood and Built Environment. In terms of the CDC clinical questions, SDoH were only examined as predictors of outcome (prognosis) and no studies examined SDoH in relation to diagnosis or treatment/rehabilitation. The Guideline includes some commentary on health literacy and socioeconomic status. Overall, social determinants of health are largely unrepresented as important or meaningful variables influencing the Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children, or in the studies that informed the Guideline.

Keywords: brain injury; concussion; pediatric; socioeconomic status.

PubMed Disclaimer

Conflict of interest statement

Dr. Cook has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. Dr. Iverson serves as a scientific advisor for NanoDx™, Sway Operations, LLC, and Highmark, Inc. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs.

For the other authors, no competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Proportion of studies examining social determinants of health domains.
FIG. 2.
FIG. 2.
Proportion of studies examining health equity variables.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Tarazi C, Skeer M, Fiscella K, et al. . Everything is connected: social determinants of pediatric health and disease. Pediatr Res 2016;79(1-2):125–126; doi: 10.1038/pr.2015.220 - DOI - PubMed
    1. Viner RM, Ozer EM, Denny S, et al. . Adolescence and the social determinants of health. Lancet 2012;379(9826):1641–1652; doi: 10.1016/S0140-6736(12)60149-4 - DOI - PubMed
    1. Centers for Disease Control and Prevention. Social Determinants of Health: Know What Affects Health. Available from: https://www.cdc.gov/socialdeterminants/index.htm [Last Accessed; 6/8/2022].
    1. U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion. Healthy People 2030. Available from: https://health.gov/healthypeople/objectives-and-data/social-determinants... [Last Accessed; March 9, 2021].
    1. U.S. Department of Health and Human Services OoDPaHP. Healthy People 2020. Washington, DC: U.S.; Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determ... [Last Accessed; March 9, 2021].