Understanding the Independent Impact of Social Determinants of Health on Resource Utilization and Health Outcomes in Civilian Post-Traumatic Stress Disorder: A Real-World Evidence Analysis

This work was sponsored by Otsuka Pharmaceutical Background: Research on civilian PTSD is scarce despite civilians accounting for a larger proportion of PTSD diagnoses and costs than veterans. This study assessed the independent effects of PTSD and social determinants of health (SDoH) on healthcare resource utilization (HCRU) and extrapolated costs. Secondary objectives assessed self-rated outcomes including self-rated physical and mental health, and health-related quality of life (HRQoL) . Methods: Using 2018-2022 data from the All of Us database, we examined differences in health outcomes associated with SDoH disparities in propensity-matched samples (n=841) of civilians with and without PTSD. We conducted multiple linear regressions for 16 outcomes and correlated independent variables to separate the independent contributory effect of PTSD and SDoH. Results: PTSD and SDoH independently contributed to poorer outcomes. After propensity matching, PTSD accounted for significant proportion of the $52.6 billion difference in outpatient (94%), emergency department (6%) and psychiatric visits. The direct economic burden of independent SDoH factors was $12.6-18.9 billion. In addition, SDoH factors contributed to more than half of poor self-rated outcomes compared with the disease itself. Employment status, stress, support, and relationships domains had the largest contributory effect to both higher healthcare resource utilization and lower well-being. Conclusion: After matching, civilians with PTSD had higher HCRU and economic burden to the health system and lower self-reported HRQoL than those without PTSD. SDoH domains related to employment, level of stress, relationships, and level of support contributed to poor outcomes.