Quantifying the independent impact of social determinants of health and posttraumatic stress disorder on resource utilization and health outcomes in civilians.

Social determinants of health (SDoH) and posttraumatic stress disorder (PTSD) are well-documented risk factors for poor health outcomes, yet their independent contributions to healthcare resource utilization (HCRU) and patient-reported quality of life remain unclear. This retrospective study, using the All of US database, compared civilians with and without PTSD (n = 747, matched on age, sex at birth, race, and ethnicity) and examined whether differences in SDoH, beyond the matched demographics, were associated with poorer health outcomes. Multiple linear regressions were conducted for twelve health outcomes related to HCRU and patient-reported well-being to separate the independent contributory effect of PTSD and SDoH. Across both HCRU and patient-reported well-being, PTSD patients had worse outcomes. SDoH factors accounted for 23.2 % of Outpatient Visits and 50.1 % of Emergency Room Visits among civilians, translating to a $8.82 billion health system burden. The SDoH domains of Employment Status, Stress, and Discrimination were significantly associated with increased HCRU. Further, SDoH factors contributed to more than half (52.4-84.5 %) of poor self-rated well-being outcomes compared with PTSD itself. Self-reported outcomes were affected by a variety of SDoH domains, most prominently Employment Status, Education, and Relationships. These results offer insight into the potential significant independent contribution of unfavorable SDoH in worsening health outcomes among civilians with PTSD.