# Health Equity & Social Determinants — GCMD Library living collection Updated: n/a · 9 episodes · 39 cited statements ## Episodes ### Equity in Trauma Care - [Equity in pediatric trauma care: screening for social determinants of health](https://library.globalcastmd.com/watch/equity-in-pediatric-trauma-care-screening-for-social-determinants-of-health-16550) — video · 1:24 · [machine version](https://library.globalcastmd.com/watch/equity-in-pediatric-trauma-care-screening-for-social-determinants-of-health-16550.md) - [Social determinants of health as drivers of inequities in pediatric injury](https://library.globalcastmd.com/article/social-determinants-of-health-as-drivers-of-inequities-in-pediatric-injury-16580) — article · [machine version](https://library.globalcastmd.com/article/social-determinants-of-health-as-drivers-of-inequities-in-pediatric-injury-16580.md) - [Strategies for addressing social drivers of health at US trauma centers](https://library.globalcastmd.com/article/strategies-for-addressing-social-drivers-of-health-at-us-trauma-centers-16587) — article · [machine version](https://library.globalcastmd.com/article/strategies-for-addressing-social-drivers-of-health-at-us-trauma-centers-16587.md) ### Health Systems & Access - [Addressing health equity in pediatric surgical care in the United States- Progress and challenges](https://library.globalcastmd.com/article/addressing-health-equity-in-pediatric-surgical-care-in-the-united-states-progres-16571) — article · [machine version](https://library.globalcastmd.com/article/addressing-health-equity-in-pediatric-surgical-care-in-the-united-states-progres-16571.md) - [Understanding area-based socioeconomic deprivation indices in health research](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592) — podcast · 25:17 · [machine version](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592.md) ### Diversity & Inclusion - [Update Course Rewind: Diversity, Equity, and Inclusion 2021](https://library.globalcastmd.com/watch/update-course-rewind-diversity-equity-and-inclusion-2021-5231) — podcast · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-diversity-equity-and-inclusion-2021-5231.md) - [Update Course 2021: DEI – CONCORDANCE AND POST OP COMPLICATION STUDIES](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414) — video · [machine version](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414.md) - [The First Generation of Asian American Pediatric Surgical Trainees in North America](https://library.globalcastmd.com/article/the-first-generation-of-asian-american-pediatric-surgical-trainees-in-north-amer-16567) — article · [machine version](https://library.globalcastmd.com/article/the-first-generation-of-asian-american-pediatric-surgical-trainees-in-north-amer-16567.md) - [Qualities and characteristics of applicants associated with successful matriculation to pediatric surgery fellowship training](https://library.globalcastmd.com/article/qualities-and-characteristics-of-applicants-associated-with-successful-matricula-16585) — article · [machine version](https://library.globalcastmd.com/article/qualities-and-characteristics-of-applicants-associated-with-successful-matricula-16585.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=0) Case presentation: delayed appendicitis diagnosis in a black adolescent (Ep 7) - [5:11](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=311) Pediatrics 2020 study: racial disparities in healthy children's surgical outcomes (Ep 7) - [10:58](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=658) Physician-patient racial concordance and infant mortality (Ep 7) - [19:22](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1162) Biological mechanisms: toxic stress and allostatic load (Ep 7) - [22:10](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1330) Institutional and community interventions to address disparities (Ep 7) - [0:00](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=0) Introduction to area-based socioeconomic deprivation indices (Ep 5) - [2:19](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=139) Defining area-based indices and their components (Ep 5) - [4:56](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=296) Systematic review methodology and findings (Ep 5) - [7:37](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=457) Methodological dimensions of index construction (Ep 5) - [11:53](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=713) The role of race in deprivation indices (Ep 5) - [15:20](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=920) Other variable considerations and policy applications (Ep 5) - [20:00](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1200) Deficit vs. strengths-based frameworks (Ep 5) - [21:55](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1315) Geographic scale: zip code vs. census tract (Ep 5) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - Race is a social construct, not a biological one, challenging historical arguments that genetic factors explain health disparities such as hypertension in African-Americans. — Meera Kotagal (opinion) [Ep 7 · 5:38](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=338) - Anchor bias—when an initial diagnostic decision causes subsequent providers to view the patient through that lens—may contribute to delayed diagnosis in patients presenting multiple times with the same complaint. — Dan (clinical) [Ep 7 · 4:03](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=243) - Toxic stress and allostatic load have neurobiological mechanisms that contribute to adverse health outcomes, educational attainment, and economic outcomes, with effects beginning in early childhood and even prenatally. — Garcia (clinical) [Ep 7 · 19:22](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1162) - Maternal mortality between black and white mothers in the United States differs by over 300%, with young black women dying even when they are residents with access to prenatal care at health institutions. — Lee (epidemiological) [Ep 7 · 17:19](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1039) - Higher infant mortality in black newborns may be a continuation of physiological stress experienced in utero, including higher prematurity rates. — Lee (clinical) [Ep 7 · 17:19](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1039) - Emergency department literature shows disparities in pain treatment for patients with appendicitis and other conditions, with questions about whether pain is treated equally across patient populations. — Meera Kotagal (clinical) [Ep 7 · 13:40](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=820) - Gastroschisis mortality is close to zero in the United States due to TPN and NICU resources, but was close to 100% in many resource-limited settings, particularly due to unavailability of TPN and social concerns around the diagnosis. — Meera Kotagal (epidemiological) [Ep 7 · 11:54](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=714) - Pipeline programs to increase diversity must start early—not at the college level—to provide opportunities to underrepresented groups. — Meera Kotagal (opinion) [Ep 7 · 25:03](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1503) - The University of Michigan's cultural complications curriculum provides a framework for surgical departments to discuss cases involving bias and gender schemas in a format similar to morbidity and mortality conferences. — Meera Kotagal (clinical) [Ep 7 · 25:03](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1503) - Addressing health disparities requires moving beyond hospital walls to tackle social determinants of health and poverty at their roots, not just applying band-aids when patients present for care. — Meera Kotagal (opinion) [Ep 7 · 25:03](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1503) - Community-based interventions must be done in partnership and solidarity with community voices, not in isolation, to understand problems from the community's perspective rather than institutional assumptions. — Meera Kotagal (opinion) [Ep 7 · 29:43](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1783) - Area-based socioeconomic deprivation indices measure neighborhood context at census tract or zip code level — Meera Kotagal (clinical) [Ep 5 · 2:35](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=155) - Complex socioeconomic deprivation indices are better predictors of and have better association with health outcomes than any single measure alone — Meera Kotagal (epidemiological) [Ep 5 · 4:42](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=282) - The systematic scoping review identified over 3000 articles, which narrowed to over 1000 abstracts after excluding duplicates, yielding 44 potential indices — Meera Kotagal (epidemiological) [Ep 5 · 5:29](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=329) - After excluding indices that were too geographically broad or limited to single states, 15 indices remained for review — Meera Kotagal (epidemiological) [Ep 5 · 5:44](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=344) - The Social Vulnerability Index (SVI) was developed to assess vulnerability to disaster and includes race because communities with higher proportions of minority individuals are more vulnerable to disaster due to structural racism — Meera Kotagal (epidemiological) [Ep 5 · 7:01](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=421) - Most deprivation indices include measures of income/poverty, education, and employment — Meera Kotagal (clinical) [Ep 5 · 8:56](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=536) - The Social Vulnerability Index used expert consensus to identify which factors should be included — Meera Kotagal (clinical) [Ep 5 · 9:19](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=559) - Some indices use statistical factor loading methods that weight variables based on how much variation they explain in the sample — Meera Kotagal (clinical) [Ep 5 · 9:30](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=570) - Most indices output results by percentile rank, but some use absolute values — Meera Kotagal (clinical) [Ep 5 · 9:51](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=591) - For the Material Community Deprivation Index, the top quintile (top 20% most deprived) contains more variation than the other 80% combined — Meera Kotagal (epidemiological) [Ep 5 · 10:24](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=624) - Four of the 15 reviewed indices include race or ethnicity in their composition — Meera Kotagal (epidemiological) [Ep 5 · 12:59](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=779) - A neighborhood's racial composition is not in itself a marker of socioeconomic deprivation; race is a social construct, not a biological one — Meera Kotagal (opinion) [Ep 5 · 13:42](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=822) - When measuring race in deprivation indices, what is actually being measured is structural racism and how racism manifests, not race itself — Meera Kotagal (opinion) [Ep 5 · 13:56](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=836) - There are higher rates of vulnerability after disaster in communities with higher percentages of Black residents, even after controlling for socioeconomic status — Meera Kotagal (epidemiological) [Ep 5 · 14:12](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=852) - If trying to assess individual-level racial inequities while controlling for area-level racial makeup in a deprivation index, it impacts the results — Meera Kotagal (clinical) [Ep 5 · 14:40](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=880) - Four or five indices include transportation availability as part of their metric — Meera Kotagal (epidemiological) [Ep 5 · 16:10](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=970) - Transportation measures like car ownership are region-dependent; in Manhattan, percentage of car ownership is not reflective of community deprivation as it might be elsewhere in the United States — Meera Kotagal (clinical) [Ep 5 · 16:17](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=977) - Non-English primary language creates barriers to healthcare access and health interventions, but not all non-English primary language communities are deprived or lack resources — Meera Kotagal (clinical) [Ep 5 · 17:13](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1033) - There is a role for multiple indices because each has advantages and disadvantages; the goal should not be a single index for all studies — Meera Kotagal (opinion) [Ep 5 · 18:25](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1105) - MassHealth uses census-tract neighborhood stress index scores to adjust payments according to patient social risk — Meera Kotagal (guideline) [Ep 5 · 18:57](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1137) - CMS's Accountable Care Organization REACH model adjusts reimbursement rates based on area deprivation — Meera Kotagal (guideline) [Ep 5 · 19:18](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1158) - Policy use of deprivation indices reflects understanding the difference between equality and equity, recognizing that equity requires providing additional resources to reach the same outcome — Meera Kotagal (opinion) [Ep 5 · 19:37](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1177) - Deprivation indices focus on deficits within communities, which allows identification of gaps that can be remedied to make positive impact — Meera Kotagal (opinion) [Ep 5 · 21:07](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1267) - Deprivation indices do not measure community well-being, social cohesion, or how communities thrive; other tools like social dynamics modeling can demonstrate community strengths — Meera Kotagal (clinical) [Ep 5 · 21:30](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1290) - Most indices use census tract level; Area Deprivation Index is available at census block group level; Community Need Index and Distressed Communities Index are only available at zip code level — Meera Kotagal (clinical) [Ep 5 · 22:47](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1367) - Zip codes can be variable in size and may include multiple different types of communities, which can cause loss of signal at the zip code level — Meera Kotagal (clinical) [Ep 5 · 23:03](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1383) - In Flint lead analysis, using zip codes failed to identify a signal because zip codes extended beyond city boundaries into suburban areas, but census tract level analysis identified the significant problem — Meera Kotagal (epidemiological) [Ep 5 · 23:16](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1396) - Zip codes are sometimes used because data can be more complete, no geocoding is required, and privacy/confidentiality concerns are addressed, but there is significant heterogeneity within zip codes — Meera Kotagal (clinical) [Ep 5 · 23:51](https://library.globalcastmd.com/watch/understanding-area-based-socioeconomic-deprivation-indices-in-health-research-16592?t=1431) ## Host summaries Recaps by a host of what the experts said — not the host's own clinical position. - African-American children with ASA 1-2 status had over threefold higher 30-day mortality after routine operations compared to other children in the NSQIP database study of 170,000+ children. — Meera Kotagal summarizing the discussion [Ep 7 · 7:10](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=430) - African-American children with ASA 1-2 status had 18% greater odds of post-operative complications and 7% greater odds of serious adverse events (cardiac arrest, sepsis) after routine operations. — Meera Kotagal summarizing the discussion [Ep 7 · 7:10](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=430) - Black newborns have a 58% reduction in mortality when treated by black physicians, based on Florida data from 1992-2015 covering 1.8 million births. — Meera Kotagal summarizing the discussion [Ep 7 · 13:40](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=820) - Racial concordance between physician and newborn affected neonatal mortality but did not impact maternal mortality in the Florida study. — Meera Kotagal summarizing the discussion [Ep 7 · 24:11](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1451) - A highly educated black woman (e.g., a lawyer) has a higher risk of dying in childbirth than a white woman with only a high school education, as demonstrated by Collins from Chicago 20 years ago. — Garcia summarizing the discussion [Ep 7 · 19:22](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1162) - Michael Marmot's work demonstrated that gainfully employed individuals in the UK National Health System had higher mortality rates the lower they were on the socioeconomic ladder, showing disparities are not unique to racial minorities. — Garcia summarizing the discussion [Ep 7 · 19:22](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1162) - Living in the neighborhood around Cincinnati Children's Hospital and not leaving by age 10 has profound negative effects on life expectancy and life trajectory. — Meera Kotagal summarizing the discussion [Ep 7 · 25:03](https://library.globalcastmd.com/watch/update-course-2021-dei-concordance-and-post-op-complication-studies-5414?t=1503) --- Educational content from recorded physician discussions — not medical advice. 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