ArticleBMC musculoskeletal disorders2026
Associations between food insecurity, neighborhood-level socioeconomic disadvantage, and humeral shaft fracture healing: a retrospective study.
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHumeral shaft fractures are common injuries with a high risk of nonunion, particularly when treated nonoperatively. Food insecurity—a modifiable aspect of social disadvantage—is prevalent in orthopedic trauma populations and may adversely impact bone healing. This study aimed to evaluate associations between neighborhood-level socioeconomic disadvantage and humeral shaft fracture healing progression, and investigate current food insecurity screening and management practices.
methodsAdult patients with humeral shaft fractures at two urban Level-1 trauma centers from 2016 to 2023 were retrospectively reviewed. Patients were included if they had a validated 2-item food insecurity screen within six months of diagnosis. The primary outcome was progression of fracture healing, assessed through time to clinical union and Radiographic Union Score for Humeral fractures (RUSHU) scores. The secondary outcome was food insecurity screening rates and management patterns. Socioeconomic disadvantage was measured using the state-level Area Deprivation Index (ADI) decile and Social Vulnerability Index (SVI). Multivariable regression, Cox proportional hazards analysis, and chi-squared testing were used to assess associations.
resultsOf 46 eligible patients, 11% screened positive for food insecurity, and 19% had non-unions. Higher SVI quartiles were associated with significantly longer time to union (HR 0.054–0.073, p < 0.01). SVI and ADI were not significantly associated with RUSHU scores at 6 weeks or 12 weeks. Only 3.6% of all patients with a humeral shaft fracture were screened for food insecurity, with significantly lower screening rates in nonoperatively managed patients (2.5% vs. 6.1%; p < 0.01).
conclusionNeighborhood-level socioeconomic disadvantage is independently associated with delayed humeral shaft fracture union but is not associated with different rates of callus formation on early radiographs, suggesting that social factors may mediate long-term fracture healing in ways that are not obvious in the short-term. Food insecurity is severely under-screened and undertreated, representing a missed opportunity for intervention as a potential factor associated with delayed time to union. Routine screening and support for at-risk patients may represent actionable steps to improve musculoskeletal outcomes and address socioeconomic disparities in fracture healing.
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