Pattern · VF-P18 · On the register since October 2026
Social and material disadvantage lengthens time in the system and lowers recovery
In non-UK cohorts, homelessness goes with far more delayed-discharge designation, and greater social need with lower rehabilitation function. A UK deprivation gradient is untested.
Register's basis, before re-grading: Provisional: two independent non-UK cohorts in one monthly cycle (Ontario administrative data and a US physiotherapy cohort), neither testing a UK deprivation gradient; awaits a second cycle and UK evidence
Status now
Provisional
Every pattern enters here, never higher. Its first entry names what evidence would qualify, contest or discard it. The publication's own inferences stay here until external evidence or events move them.
How we grade →Path through the register
Holds across
- D01 Acute Frailty
- D02 Clinical Psychology (not spanned)
- D03 Palliative Care
- D04 Therapies & AHPs
- D05 OPAT (not spanned)
How it grades
- The claim the evidence supports
- In non-UK cohorts, homelessness goes with far more delayed-discharge designation, and greater social need with lower rehabilitation function. A UK deprivation gradient is untested.
- Starting point
- D04 silent makes no claim on social determinants of rehabilitation
- The evidence
- 2 test or bear on it 1 cited but do not test it 0 not yet read at source 0 endorsements, not counted Domains earned: D04 of the 3 it spans
- What would prove it wrong
- A UK analysis finding no gradient after adjusting for case mix.
- What the re-grade found
- One cited number belongs to a different study (the Cornwall evaluation), and the acute frailty tag rests on an all-age cohort with a mean age of 48.
A grade measures how certain the evidence we have assessed makes the claim as worded: its own sources and the settled evidence for its domains. Low means unproven, not implausible. What a grade means →
How we grade →The longitudinal record
- Provisional
Entered the register
New this month. In Ontario, recent homelessness carried an alternate-level-of-care designation in 9.1% against 2.0% of matched patients from the most materially deprived neighbourhoods (rate ratio 4.51; 51,377 patients); in a US prospective physiotherapy cohort, greater social-need burden independently lowered discharge function (B=-2.35; n=164, with attrition). Both are non-UK. Rural hospice disparities already recorded under VF-P12 bear on the same observation. Disconfirmation condition: a UK analysis of delayed discharge or rehabilitation outcome showing no deprivation gradient after case-mix adjustment would qualify or discard this pattern.
Evidence PMID 42467431 PMID 42816756 PMID 40331105Patients with recent homelessness were designated as awaiting alternative care at more than four times the rate of matched comparators in OntarioIdentification is the easy part: frailty scores predict mortality, and social disadvantage marks who is held up
Cite as: The Value Forge, pattern VF-P18 — “Social and material disadvantage lengthens time in the system and lowers recovery”, tracked since 2026-10. CC BY 4.0. Register generated 2026-10-10.