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.
I am looking into what disease state factors are associated with increased rates of recurrence in salivary gland cancer patients. For example, several factors I am studying include salivary gland subtype, primary site of tumor, perineural invasion, lymphovascular invasion, extracapsular spread, etc. When gathering data on each patient’s case, I will also be recording demographic information, such as sex, age, ethnicity, race, etc. However, I am also interested in looking specifically into social determinants and their associations with recurrence rate. My data is unfortunately limited to what is on Epic and so more in-depth information on patients, such as income, education, occupation, social support, etc., would be inconsistently available. However, if available, social stratifiers that would be most relevant are sex, race/ethnicity, income, education, and occupation. Income and education would be interesting, as they are used to assess the outcome of social stratification processes, which may relate to how the patient is also treated by the medical system. How well a patient follows up with their oncologist would be affected by their interactions with the healthcare system, which can be captured in part by measuring patients’ treatment by social stratification processes. Occupation would be another noteworthy factor, as it is used as an indicator of socioeconomic position, which may also capture patients’ interactions with the healthcare system. The most relevant intermediary factors would include behavioral and the health care system. Behavioral factors I would be most interested in are smoking, alcohol consumption, and sexual behavior, as these are biologically linked with head and neck cancers. Patients’ access to the health care system would also be relevant, as this would affect their primary treatment in the first place, how ably they can follow-up with their provider, medication adherence, etc, all of which can contribute to recurrence.
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?
Current literature on salivary gland cancer focusing on social determinants of health is sparse and in between. The few papers I have found have investigated structural stratifiers such as gender, race/ethnicity, income, education, and county attributes and their association with overall survival. The majority of these studies are derived from a single database as well (SEER). There would be room for investigating intermediary determinants and many other structural stratifiers.