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

Abstract This study discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic literature from neurosurgery. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. The search was limited to articles published from January 1st, 1990 to December 3rd, 2020. All articles retrieved from the database searches were exported and stored in EndNote X.9 bibliographic and reference manager. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The search resulted in 5,940 studies. After exclusions were made during data extraction, 99 studies remained for final analysis. Of the 99 included studies, 6 social determinants were analyzed, with 3 studies evaluating 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 sub-specialties, 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. Research gaps include the remaining neurosurgical subspecialties and numerous other SSDOH. These gaps should be areas of future study, with the goal of aligning research with new healthcare initiatives and assuring that the SSDOH are accounted for.