Contextual nonmedical health factors and critical care-related outcomes: a systematic review

Disparities in non-medical health factors, such as social determinants of health (SDoH), are associated with increased risk of negative health outcomes. Leveraging contextual (or area-based) measures of SDoH is essential for uncovering broader factors influencing disparities in critical care-related outcomes. Our objective is to review evidence analyzing the association between contextual SDoH obtained from publicly available databases and critical care-related outcomes in the United States (US).

We conducted searches in the Web of Science, PubMed, Cochrane, and Embase electronic database to obtain clinical studies utilizing SDoH datasets from publicly available data sources and analyzed these studies for associations between critical care-related outcomes and SDoH (search date June 8th, 2025). We excluded non-English articles, reviews, editorial commentaries, letters to editors, studies without intensive care unit (ICU) patients or SDoH variables, studies based on countries outside of the US and studies that lacked full text or contained only the abstract. We extracted cohort characteristics, SDoH measures and domains, SDOH database characteristics, ICU admissions and outcomes, analytical method used for determining the association between SDoH and ICU variables, and significant SDoH variables.

We identified 87 publications (44 with pediatric patients, 40 with adult patients, and 3 with a mixture of both) and study population characteristics (e.g., surgical or specific disease-diagnosed patients). Child Opportunity Index and American Community Survey were the top platforms utilized for acquiring SDoH in pediatric and adult cohorts, respectively, followed by Area Deprivation Index and Social Vulnerability Index in both cohort types. Area-level granularity included boundaries determined by counties, ZIP codes, census block groups and census tracts.

Among five SDoH domains, economic stability was found to be the top investigated SDoH category for critical care-related outcomes. Contextual SDoH variables, indicating more vulnerable and adverse conditions, were associated with higher ICU admissions, greater need for ICU resource utilization, longer ICU duration, higher likelihood of developing critical illnesses, worsened life quality following ICU discharge, and higher mortality. Social determinants of health offer a broad area for modifiable intervention targets. Public databases serve as facilitators towards SDoH integration into electronic health records, promoting value-based care and mitigating health inequities.