The relationship between social parameters and life satisfaction and functional outcomes: a systematic review and meta-analysis.

PURPOSE: Association between social determinants of health (SDoH) and functional outcomes and life satisfaction after traumatic brain injury (TBI) has not been systematically analyzed, constituting a knowledge gap.

MATERIAL AND

METHODS

We searched six databases on August 15, 2025, for observational studies reporting associations between SDoH and functional outcomes or life satisfaction. We applied PROGRESS-Plus framework to analyze data. We conducted meta-analysis and visualized results for certainty assessment.

RESULTS

We included 31 studies of excellent and good quality involving 101,239 adults with TBI (85% male/men, mean age 38.8 ± 17.1 years). Education, social capital, and occupation were the most commonly examined SDoH. Meta-analysis revealed significant gender/sex differences in the Functional Independence Measure (FIM) Total, Cognitive, and Motor scores (standardized mean difference, SMD 0.13 [0.09, 0.16]; -0.16 [-0.32, -0.01]; 0.20 [0.07. 0.33], respectively); and Glasgow Outcome Scale Extended (GOS-E) scores (SMD 0.35 [0.05, 0.66]). No significant gender/sex effect was observed for life satisfaction (SMD 0.23 [-0.09, 0.55]). Moderate certainty suggests links between race/ethnicity and social capital with GOS/GOS-E; and education and age with employment. All other findings were low or very low in certainty.

CONCLUSION

Evidence on SDoH is essential for advancing our understanding of functional outcomes and life satisfaction after TBI. PROSPERO: CRD42024547456.