Impact of Social Determinants of Health on Patient-Reported Outcome Measures and Survey Completion in Orthopaedic Trauma

OBJECTIVES: To compare demographic characteristics and social determinants of health between patients who completed at least one Patient-Reported Outcomes Measurement Information System Global Health 10 (PROMIS) survey and patients who did not, and to identify patient factors associated with worse PROMIS outcomes among patients who completed surveys. DESIGN: Retrospective cohort. SETTING: Multicenter metropolitan health care system. PATIENT SELECTION CRITERIA: Orthopaedic trauma surgical patients from 2018 to 2024. OUTCOME MEASURES AND COMPARISONS: Completion of at least one PROMIS survey defined patients as completers, and those who did not complete a survey was classified as noncompleters. Area Deprivation Index (ADI) was calculated from 1 (least deprived) to 10 (most deprived) and grouped into quintiles. A logistic regression model was used to identify predictors of PROMIS completion and outcomes based on demographics, comorbidities, and ADI. RESULTS: A total of 5713 patients were included (3433 women; average age 60.0 ± 20.2 years). There were 3451 PROMIS completers (60.4%). Asian patients (odds ratio [OR]: 0.49, 95% CI: 0.34-0.70, P < 0.001), Black or African American patients (OR: 0.36, 95% CI: 0.29-0.45, P < 0.001), Hispanic or Latino patients (OR: 0.44, 95% CI: 0.33-0.58, P < 0.001), and patients in the highest quintile ADI (OR: 0.51, 95% CI: 0.41-0.65, P < 0.001), as well as those with higher ADI (OR: 0.53, 95% CI: 0.45-0.63, P < 0.001) and medium ADI (OR: 0.76, 95% CI: 0.65-0.90, P = 0.004), were significantly less likely to complete PROMIS surveys. Black or African American patients (OR: 2.89, 95% CI: 2.04-4.08, P < 0.001), Hispanic or Latino patients (OR: 2.43, 95% CI: 1.59-3.73, P < 0.001), and patients in the highest ADI quintile (OR: 1.86, 95% CI: 1.34-2.59, P < 0.001), as well as those with higher ADI (OR: 1.52, 95% CI: 1.20-1.92, P = 0.004), medium ADI (OR: 1.43, 95% CI: 1.17-1.76, P = 0.002), and lower ADI (OR: 1.22, 95% CI: 1.01-1.48, P = 0.04), were significantly more likely to be in the lowest PROMIS score quartile. CONCLUSIONS: Race/ethnicity and higher ADI were independently associated with poor PROMIS survey completion and worse outcomes following orthopaedic trauma. These findings underscore the need for targeted interventions to improve survey completion and outcomes among socioeconomically disadvantaged populations. LEVEL OF EVIDENCE: Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.