Vitamin D supplementation in pregnant or breastfeeding women or young children for preventing asthma.

There have been incredible advances in the field of hand, upper extremity, and microvascular surgery throughout the last several decades. For example, surgeons can harvest a portion of the medial femoral condyle from the femur to help a proximal scaphoid nonunion heal or use three-dimensional planning and printing of osteointegrative materials to correct a forearm malunion. Notably, however, many of these advances are available to a small subset of the population. In fact, there is a growing body of evidence that many disparities between populations persist and have a substantial impact on access to and outcomes from hand and upper-extremity care. For example, patients with public insurance and those who speak a language other than English experience significant delays in their ability to receive surgery or have differential rates of surgery for various types of fractures (eg, distal radius fractures, clavicle, and proximal humerus). Truong et al demonstrated that patients undergoing distal radius fracture surgery facing adverse social determinants of health (SDOH) (eg, economic and educational) were more likely to experience 90-day (eg, emergency department visits and infections) and 1-year (eg, nonunion and chronic regional pain syndrome) complications. The recognition of the importance of SDOH—the conditions in which people are born, grow, live, work, and age that influence their health and well-being—has grown exponentially, with an over 1,100% increase in papers being published on the topic in the last 15 years. Taken together, these investigations estimate that 40% to 80% of overall health outcomes are attributable to social status. In their article, “Mental and Physical Health Disparities in Patients With Carpal Tunnel Syndrome Living With High Levels of Social Deprivation”, Dr Wright and colleagues were among the first to investigate and report on the association of social deprivation (and other SDOH) with patient-reported outcomes in hand and upper-extremity surgery. Social deprivation is often measured by the Area Deprivation Index, which was created by Singh in 2003, and is a factor-based index that uses 17 US Census indicators (eg, poverty, education, and employment) to categorize regions. The variables are weighed and summed for each zip code tract and transformed into a standardized index with higher numbers indicating greater levels of deprivation and lower numbers indicating lesser levels of deprivation. In this cross-sectional study, conducted more than 7 years ago, Wright et al evaluated more than 360 patients presenting for the evaluation of carpal tunnel syndrome and demonstrated that those patients living in the most deprived quartiles had worse mean outcome scores than those living in the least deprived quartile, even while controlling for variables including comorbidities, age, and tobacco use. The authors also noted that patients living in the most deprived areas reported greater levels of pain interference, anxiety, and depression. In a subsequently published study, the same authors evaluated a larger sample of 7,500 adults presenting to orthopedic subspecialty clinics (eg, joint reconstruction and sports medicine) and noted similar phenomena, demonstrating the prevalence of such issues. Although the authors do not imply causation, the implications of such associations are of great importance to hand, orthopedic, and plastic surgeons, hospital administrators, and policy-makers, and these results have contributed substantially to our continued work in understanding how to address psychological and social factors in our patients. Although social deprivation itself is not easily modifiable, in this landmark study, the recognition by Wright et al of the effects of SDOH created the foundation for further efforts to measure and eventually try to address SDOH in hand surgical care. This work has been built upon with authors demonstrating that patients with higher area-level deprivation have greater delays in time to surgery for distal radius fractures, attend fewer clinic visits after distal radius fracture treatment, have more severe cubital tunnel symptoms when presenting to hand surgeons, and attend fewer hand therapy visits and obtain less active range of motion after flexor tendon repair. As the health care landscape continues to shift from one that rewards volume to one that incentivizes accountable and patient-centered care, novel approaches to measuring and accounting for—modifying when possible—social risks can help us better meet the needs of our patients and their communities. This is becoming increasingly relevant, as for example, the Centers for Medicare and Medicaid Services have incorporated social deprivation into alternative payment models, such as the mandatory Centers for Medicare and Medicaid Services—Transforming Episode Accountability Model. Similarly, the Centers for Medicare and Medicaid Services has mandated the reporting of patient-reported outcome measures in a p