Background

Studies have shown that social determinants of health (SDOH) are powerful predictors of health outcomes. This study seeks to build upon this knowledge base by determining the association between SDOH and the completion of metabolic and bariatric surgery (MBS) among adolescents.

Methods

Electronic health record data were collected from adolescents (N=72, mean age 15.74 years, SD 1.37, range 12-18, 70.4% female, 33.8% non-Hispanic Black (NHB), 29.6% multiracial/other, 58.2% Hispanic; mean body mass index (BMI), Z-Score 3.43 [SD 1.08, range 1.76-7.32; %BMIp95 median 184%, range 105%-260%]) attending the adolescent MBS program at Children's Health System of Texas. MBS completion status (Y/N) was analyzed by the following SDOH domains: health literacy; social support; food-, transportation-, energy-, digital-, and housing insecurity; and tobacco exposure via Fisher exact, chi-square, and logistic regression analysis. Results. Most (90.3%) participant families reported at least one SDOH and 62.5% reported >2 SDOH. The most frequently reported SDOH were food insecurity (26.4%), health literacy challenges (19.7%), and lack of social support (18.8%). There were no age or insurance status (public/private) differences in SDOH prevalence or frequency, but NHB (87.5%) and Hispanic (58.5%) families were more likely to report >1 SDOH vs. none (p=0.02, p<0.01, respectively). No association was found between MBS completion and SDOH occurrence (OR 1.35, 95% CI 0.05-12.47, p=0.79). Conclusion. These findings highlight the high prevalence of SDOH and thus the need to capture this information in the MBS pre-operative stage to maximize MBS completion and health outcomes among adolescents.