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Evaluating Associations Between Health Equity and High-Quality Care in Hand and Upper-Extremity Care: A Systematic
Angel X Xiao1, Katherine R Miclau2, Mandeep Kaur2
1Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
The Journal of Hand Surgery
|May 8, 2026
Summary
Social determinants of health significantly impact access to hand and upper-extremity care. Economic disparities, particularly insurance status, are major barriers to timely and quality treatment.
Area of Science:
- Orthopedic Surgery
- Public Health
- Health Services Research
Background:
- Timely and high-quality hand and upper-extremity care is crucial for patient well-being.
- Social determinants of health (SDOH) are increasingly recognized as significant factors influencing healthcare access and outcomes.
- Existing research highlights demographic factors like age and BMI, but the role of SDOH requires further investigation.
Purpose of the Study:
- To evaluate the associations between health inequities, framed by the PROGnosis RESearch Strategy (PROGRESS) framework, and access to timely, high-quality hand and upper-extremity care.
- To utilize the three-delays model to understand how SDOH contribute to disparities in care.
- To identify specific SDOH factors affecting different stages of the patient care journey.
Main Methods:
- A systematic review of PubMed, EMBASE, and Web of Science was performed.
- Studies were identified using keywords related to SDOH in hand and upper-extremity care.
- Included studies were categorized by PROGRESS framework inequities, and analyzed using the three-delays model to assess access, delivery, and receipt of care.
Main Results:
- 75 studies were included from an initial search of 2587 articles.
- Distal radius fractures, general elective upper-extremity surgery, and upper-extremity trauma were common conditions studied.
- Socioeconomic status (particularly insurance status), place of residence, and gender/sex were the most frequently examined SDOH factors.
- Delays in receiving adequate care (delay 3) were most prevalent, followed by delays in reaching care (delay 2) and deciding to seek care (delay 1).
Conclusions:
- Numerous SDOH factors are associated with disparities in accessing timely and high-quality hand and upper-extremity care.
- Economic factors, especially insurance status, play a substantial role in the receipt of care.
- This analysis identifies key areas for intervention to promote equitable access to hand and upper-extremity care.
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