1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances, as described in the WHO reading. Explain why you chose the factors (might use Braveman article from last week to provide justification. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
My research focuses on gender disparities in presentation, treatment, and outcomes of vascular disease, particularly peripheral artery disease (PAD). Prior research shows that women with PAD experience higher rates of functional decline and may have worse clinical outcomes after invasive treatment for PAD compared to men. Despite this, women remain under-represented in contemporary PAD studies, with female populations in published literature ranging from 30-40%. Therefore, gender is an important structural stratifier in my research. It will be challenging, although important, to try to distinguish biological differences (such as smaller artery size) from differences that may be due to social constructs such as access to care and biases from researchers and clinicians (ie fewer women are prescribed statins). Important intermediary determinants, as touched upon above, are behavioral and biological factors. Ensuring the best treatment for women hinges upon understanding both biologic differences and behavioral differences. For example, our early work shows that in one national database including patients that undergo interventions for PAD, women were less likely to be smokers and less likely to have a normal BMI than men. Inequity in our understanding of PAD in women, both from a biologic and behavioral standpoint affects women throughout their lives, as critical preventative care and early interventions of disease are not provided. This is compounded by an inadequate understanding of the optimal way to treat women with advanced disease. If the cycle is not broken it will certainly affect generations to come.
2. Write a brief paragraph describing the extent to which a socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
I believe that in vascular disease/surgery research we are just beginning to scratch the surface of the disparities that exist. The vast majority of published work simply “controls for” potential social determinates of health without trying to understand mechanisms and implications. A socioecologic framework related to social determinates will be an important tool for understanding and addressing disparities in cardiovascular health and vascular interventions. Cardiovascular health is so intimately entwined with social determinates, behavior, and biology, this framework will help us understand important differences health and hopefully mechanisms for differential outcomes.