Mental and Physical Health Disparities in Patients with Carpal Tunnel Syndrome Living with High Levels of Social Deprivation
Melissa A Wright, MD; Casey Beleckas, BS; Ryan P. Calfee, MD, MSc
Washington University in St. Louis School of Medicine, St. Louis, MO
Introduction: Social, mental, and physical health have a complex inter-relationship. Each facet of health can modulate the other such that social environments can shape one's experience of disease processes. The primary aim of this study was to assess the impact of social deprivation on patient reported physical and mental health in patients with carpal tunnel syndrome (CTS) at initial presentation to a hand surgeon.
Materials & Methods: This cross sectional study analyzed data from 152 patients from 8/1/16 to 12/15/16 presenting to one of six fellowship trained hand surgeons at a single tertiary academic center with a diagnosis of CTS. Patients completed PROMIS Physical Function-v1.2, Pain Interference-v1.1, Depression-v1.0, and Anxiety-v1.0 Computer Adaptive Tests at presentation. The area deprivation index (ADI) was used to quantify social deprivation. Review of the medical record was used to determine duration of symptoms, current tobacco use, current opioid use, and the Charlson Comorbidity Index (CCI) for each patient. Statistical analysis characterized the population and compared PROMIS scores as well objective health measures between levels of social deprivation (based on most and least deprived national quartiles).
Results: Patients with CTS living in the most deprived quartile had significantly worse mean scores across all four PROMIS domains when compared to those living in the least deprived quartile (p<0.05, Figure 1). A higher proportion individuals from the most deprived quartile had a level of anxiety meeting the threshold for treatment compared to the least deprived quartile. The mean CCI was significantly higher in the most deprived quartile, as was the proportion of individuals endorsing tobacco use (Table 1). There were no differences in opioid use at presentation or symptom duration prior to presentation between ADI quartiles.
Conclusions: Patients with CTS from the most socially deprived areas report significantly worse Physical Function, Pain Interference, Depression, and Anxiety at presentation to hand surgeons. Patients from more socially deprived areas have worse objective health, with higher CCIs and more tobacco use. Social deprivation influences how CTS impacts patients and thus should be considered during treatment counseling.
Figure 1. Mean PROMIS scores for each PROMIS domain, comparing least and most deprived ADI quartiles. Bars indicate standard deviation for each mean.
Table 1. Patient characteristics for individuals in the most and least deprived quartiles. *indicates statistically significant difference, p<0.05.
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