健康的社会决定因素对先天性心脏病手术围手术期及分期结局的影响：一项系统综述。
完整摘要 · 中文译文
重要性：健康的社会决定因素（SDoH）——患者生活、成长和衰老所处的条件——越来越被认为会影响先天性心脏病（CHD）患者的健康。 目的：探讨SDoH对先天性心脏病手术后患者短期死亡率和发病率、分期结局及资源利用的影响。 证据综述：按照PRISMA指南完成了一项系统综述。从PubMed、SCOPUS、CINAHL、PYSCINFO和Cochrane五个数据库中检索1999年1月至2024年2月期间评估SDoH与儿童和成人CHD患者手术结局相关性的相关研究。纳入标准包括既往系统综述和荟萃分析、前瞻性收集试验数据的二次分析以及前瞻性或回顾性队列研究。随后的参考文献检索确定了39篇相关文章。SDoH包括患者和社区层面的指标。两名独立评审员筛选研究进行全文审查，并由专家小组进行数据提取。 发现：在确定的1，224项研究中，157篇文章进行了全文审查，最终选择121篇进行数据提取。85篇文章未涉及急性术后结局，被排除。36项研究聚焦于先天性心脏病手术后的急性或分期结局，并作为源信息。其余为使用各种数据库的回顾性队列研究。研究参与者数量范围为98至174， 352（中位数 = 6,979）。发现与院内死亡可能性较高相关的因素包括黑人种族、西班牙裔/拉丁裔族裔、医疗补助保险以及较低的社区社会经济地位。个体层面和社区层面的决定因素均与较长的分期间期、较高的并发症发生率以及更多的资源利用和再入院相关。减少医疗不公平的两个关键干预时间窗是新生儿期和青年期。 结论与意义：健康社会决定因素（SDoH）影响先天性心脏病（CHD）术后患者的急性期和分期间期结局。制定干预措施以增加获得和参与优质诊疗及院外支持的机会，可能改善短期结局并减轻系统层面的经济负担。系统综述注册。
完整摘要 · 英文原文
IMPORTANCE: Social determinants of health (SDoH)- conditions in which patients live, grow, and age,-are increasingly recognized to influence the health of patients with congenital heart disease (CHD). OBJECTIVE: To explore the impact of SDoH on short-term mortality and morbidity, interstage outcomes, and resource utilization, among patients following congenital heart surgery. EVIDENCE REVIEW: A systematic review was completed according to PRISMA guidelines. Relevant studies evaluating the association of SDoH with surgical outcomes of pediatric and adult CHD patients were identified from five databases queried including PubMed, SCOPUS, CINAHL, PYSCINFO, and Cochrane between January 1999 and February 2024. Inclusion criteria incorporated prior systematic reviews and meta-analyses, secondary analyses of prospectively collected trial data, and prospective or retrospective cohort studies. Subsequent reference searches identified 39 related articles. SDoH included patient and neighborhood level metrics. Two independent reviewers screened studies for full-text review, with data extraction by an expert panel. FINDINGS: Among 1,224 studies identified, 157 articles underwent full-text review and 121 were ultimately selected for data extraction. Eighty-Five articles did not address acute postoperative outcomes and were excluded. Thirty-six studies focused on acute or interstage outcomes following congenital heart surgery and served as the source information. The remainder were retrospective cohort studies using various databases. The number of study participants ranged from 98 to 174,352 (median = 6,979). Factors found to be linked with greater likelihood of in-hospital mortality included Black race, Hispanic/Latino ethnicity, Medicaid insurance, and lower neighborhood socioeconomic status. Both individual and neighborhood level determinants were associated with longer interstage periods, higher complication rates, as well as greater resource utilization and hospital readmissions. Two critical timespans for intervention to reduce inequities in care were the neonatal period and young adulthood. CONCLUSIONS AND RELEVANCE: SDoH impact both acute and interstage outcomes in patients following surgery for CHD. Developing interventions to increase access to and engagement with quality care and out-of-hospital support may improve both short-term outcomes and reduce systems-level financial burden. Systematic Review Registration.