Examining the underreporting of social determinants of health in randomized controlled trials published in spine journals

Social determinants of health (SDOH) are nonmedical factors that influence patient outcomes. This study aimed to determine the prevalence of randomized controlled trials (RCTs) reporting SDOH factors in their patient cohorts within several of the highest-impact spinal surgery journals. We hypothesize that SDOH factors will be infrequently reported and often miss variables such as socioeconomic status, employment status, insurance, and education level. From 2020 to 2024, the PubMed database was queried to analyze spine RCTs reporting SDOHs from four high-impact journals. For each study, we determined the age, sex, and/or gender, body mass index (BMI), the year the article was published, the country of origin of the senior author, and self-reported SDOH factors. Of the 147 included RCTs, age (95.9%), sex/gender (94.6%), and BMI (72.8%) were reported by the majority of studies. There were a total of 33 countries represented by the RCTs reporting spine outcomes, where 25 (17.0%) RCTs were conducted in the United States, 22 (15.0%) RCTs conducted in China, 11 (7.5%) RCTs in the Netherlands, 9 (6.1%) RCTs in Japan and 9 (6.1%) RCTs in Turkey. This paper provides valuable insights into the landscape of spine research and emphasizes the necessity of consistently reporting all SDOH factors. Future research can better inform clinical practice and policy decisions by addressing these considerations, ultimately improving healthcare outcomes for spine patients worldwide.