Social determinants of health and spina bifida care: Immigrant and minority health in an era of quality of life and multicenter comparative analysis

Abstract

Globally there is substantial variation in birth prevalence rates of neural tube defects. In the United States, for instance, the birth prevalence is seven cases per 10,000 live births, whereas in certain regions of Latin America, it has been reported to be as high as 96 cases per 10,000. While immigration from Latin America is often a result of social determinants, immigration itself can be understood as a social determinant of health (SDH). The Centers for Disease Control and Prevention has stated that when attempting to mitigate racial/ethnic health disparities, it should be remembered that SDH effectively determine longevity and quality of life (QOL). Subsequently, investigators have begun to recognize existing disparities through the use of the National Spina Bifida Patient Registry (NSBPR). In the face of these documented health disparities among minority populations with spina bifida, the need for timely and culturally-competent study of QOL among Hispanics/Latinos, who have the highest spina bifida prevalence, is self-evident. Furthermore, social variables have been linked with worse outcomes in national patient registries, illustrating the importance of accounting for SDH in multicenter comparative analysis. Therefore, accounting for these individual-level differences becomes even more critical, when making comparisons within SB care - a condition with a known ethnic/racial-gradient in incidence. As we face an increasingly global community, with growing travel and immigration, fresh approaches will be required, such as community-based participatory research and culturally-competent learning collaboratives, in order to address the challenges ahead.