The Social Determinants of Health of Patients with Spontaneous Lateral Skull Base Cerebrospinal Fluid Leaks

Introduction: Social determinants of health (SDOH) are known to impact the access to and outcomes of care of many otologic conditions, however little is known of SDOH amongst patients with lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks. Therefore, this study aims to explore the prevalence of SDOH risk factors self-reported by this group.

Methods: A retrospective review was conducted at a multi-site tertiary care institution from 2018 to 2024. Adults with lateral skull base sCSF leaks who completed an SDOH questionnaire within 6 months of their diagnosis and underwent surgical repair were included. The main outcome measures were self-reported SDOH risk factors, demographics and recurrence. Descriptive analysis was performed to analyze responses to the SDOH questionnaire.

Results: 111 patients met inclusion criteria. The average age was 63.1 years (range: 24-91) and average BMI was 36.4 (range: 18.3-64.4). There were 72 females (64.9%), and 101 patients (90.1%) identified as white. Forty-three patients reported high school education or less (43.0%), but only 3 patients (2.8%) resided in rural areas. Obesity (79.3%, n=88) and hypertension (74.8%, n=84) were common. The most prevalent SDOH risk factors were physical inactivity (79.3%, n=73) and poor nutrition (89.6%, n=69), followed by social disconnect (50.0%, n=36), stress (34.7%, n=26), financial strain (23.8%, n=20), lack of dental care (17.8%, n=16), food insecurity (9.7%, n=9), housing instability (8.7%, n=4), and intimate partner violence (6.8%, n=3). Ninety-one patients (89.2%) underwent surgery and 9 (8.1%) had a recurrence over an average follow-up period of 11.9 months. Heterogeneity of SDOH risk factors and a low recurrence rate precluded analysis of the impact of SDOH factors on risk of recurrence.

Conclusions: Physical inactivity and poor nutrition are highly prevalent amongst patients with lateral skull base sCSF leaks and represent important risk factors that should be addressed for general health maintenance. Research on larger more heterogeneous populations is needed to address the influence of SDOH risk factors on the outcomes of repair.