Social Determinants of Health in Thoracic Surgery: Critical Points for Understanding and Implementing Change.

Abstract

It is imperative that thoracic surgeons and their teams understand, assess, and work to mitigate adverse social determinants of health (SDOH) to achieve the best care and outcomes for patients. A narrative review was performed to identify the most up to date literature on SDOH and thoracic surgery. Manuscripts providing recommendations on the topics of lung cancer screening (LCS), treatment and outcomes for patients with thoracic disease, and systems-level efforts to address SDOH in health care were reviewed and summarized. SDOH influences access to all elements of high-quality medical care. Low household income, low educational attainment, and living in disadvantaged, underresourced, or segregated neighborhoods are all linked to lower LCS, lower rates of lung cancer surgery, and lower clinical trial participation. Thoracic surgeons must be aware of the impact of SDOH on LCS, access to treatment, surgical outcomes, and survivorship. They must incorporate their knowledge with the preoperative and perioperative care of their patients with lung and esophageal diseases as well as lung transplantation. Using examples of successful targeted programming in other spheres of health care can provide guidance on how to implement interventions to improve outcomes for thoracic surgery patients.