A Scoping Review of the Literature on the Relationship Between Social and Structural Determinants of Health and Neurosurgical Outcomes

In the present study, we performed a scoping review of the social and structural determinant of health (SSDOH)-related academic literature from neurosurgery. To identify the studies to include or consider for our systematic review, we worked with a medical librarian to develop detailed search strategies for each database. The search was limited to studies reported from January 1, 1990 to December 3, 2020. All reports retrieved from the database searches were exported and stored in EndNote X.9 bibliographic and reference manager (Clarivate, Philadelphia, Pennsylvania, USA). The reports were screened by title and abstract independently by two of the co-authors (G.G. and A.O.). Any disagreements between the 2 reviewers were resolved by a third reviewer, who was unaware of the decisions of the primary reviewers. The search resulted in 5940 studies. After exclusions during data extraction, 99 studies remained for the final analysis. From the 99 included studies, 6 social determinants were analyzed, with 3 studies evaluating the highest level of educational attainment, 14 studies evaluating gender, 52 studies evaluating race, and 41 studies evaluating economic stability. Studies referencing SSDOH were found in 8 subspecialties, with 40 studies in spine surgery, 4 studies in functional neurosurgery, 14 studies in vascular neurosurgery, 27 studies in cranial oncology, 5 studies in spinal oncology, 5 studies in pediatric neurosurgery, 1 study in trauma, and 3 studies in general/unspecified subspecialties. Research gaps included the remaining neurosurgical subspecialties and numerous other SSDOHs. These gaps should be areas of future study, with the goal of aligning research with new healthcare initiatives and ensuring consideration of SSDOHs.