Purpose
Social, mental, and physical health have a complex interrelationship with each influencing
individuals’ overall health experience. Social circumstances have been shown to influence
symptom intensity and magnitude of disability for a variety of medical conditions.
We tested the null hypothesis that social deprivation would not impact Patient-Reported
Outcomes Measurement Information System (PROMIS) scores or objective health factors
in patients presenting for treatment of carpal tunnel syndrome (CTS).
Methods
This cross-sectional study analyzed data from 367 patients who presented for evaluation
of CTS to 1 of 6 hand surgeons at a tertiary academic center between August 1, 2016,
and June 30, 2017. Patients completed PROMIS Physical Function—v1.2, Pain Interference—v1.1,
Depression—v1.0, and Anxiety—v1.0 Computer Adaptive Tests. The Area Deprivation Index
was used to quantify social deprivation. Medical record review determined duration
of symptoms, tobacco and opioid use, and the Charlson Comorbidity Index (CCI) for
each patient. Sample demographics, PROMIS scores, and objective health measures were
compared in groups defined by national quartiles of social deprivation.
Results
Patients with CTS living in the most deprived quartile had worse mean scores across
all 4 PROMIS domains compared with those living in the least deprived quartile. A
higher proportion of individuals from the most deprived quartile had a heightened
level of anxiety than those in the least deprived quartile (37.3% vs 12.6%). The mean
CCI was higher in the most deprived quartile, as was the proportion of individuals
using tobacco. There were no differences in opioid use or symptom duration between
patients from each deprivation quartile.
Conclusions
Social deprivation is associated with worse patient-reported health measures in patients
with CTS. Compared with those from the least deprived areas, patients from the most
deprived areas also have a greater comorbidity burden and higher rates of tobacco
use at presentation to a hand surgeon.
Type of study/level of evidence
Prognostic II.
Key words
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Article info
Publication history
Published online: June 23, 2018
Accepted:
May 8,
2018
Received:
August 13,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
