Integration of social determinants of health in quality indicators for colorectal cancer surgery: A scoping review

Quality indicators (QIs) are standardized measures for tracking healthcare performance. However, the integration of social determinants of health (SDoH) in developing and reporting QIs remains unclear. This scoping review explores the use of SDoH in QIs for colorectal cancer (CRC) surgery, to assess gaps and provide practical recommendations for better integration of SDoH in cancer care systems. Of 113 studies, 70 (61.9%) reported QIs for healthcare systems, 33 (29.2%) measured factors associated with QIs, and 10 (8.9%) developed QIs. SDoH were assessed in 65 (57.5%) studies, with notable gaps including inadequate adjustment for confounders and interactions, lack of additive effect assessments, and the absence of conceptual social frameworks to guide study design. To support equity in quality monitoring, future research should incorporate SDoH when describing and validating outcomes, report QIs stratified by SDoH, and develop benchmarks for variations in QIs across sociodemographic groups.