1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifies (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 current research projects are looking at the differences in chronic liver disease presentation, diagnosis and longterm outcomes based on race/ethnicity. It has been demonstrated in prior studies that patients of Latino or Hispanic ethnicity have increased rates of hepatocellular (liver) cancer from chronic liver disease (CLD), as well as increased CLD-mortality. This is particularly seen at a younger age in this population when compared to White patients. Unfortunately, because Latino/Hispanic patients have also been found to have higher rates of obesity, diabetes, alcohol consumption, and a single nucleotide polymorphism (SNP) PNPLA3 associated with worse outcomes in fatty liver disease in particular, some feel these explain the differences in outcomes. While these factors are certainly contributing, we are also interested in trying to understand the role of social determinants, as these are most likely directly affecting patients’ CLD, and also the comorbidities linked to CLD. As we recruit patients into our current study, we are looking at self-reported race/ethnicity, primary language, place of birth, housing situation, income, education, occupation, health insurance, social support, trust of healthcare providers, interactions with healthcare providers, self-reported quality of health, impact of culture and family on diet and exercise, health literacy, medication adherence, and several other factors. Worse outcomes in CLD can be explained by lifestyle (diet, lack of exercise, alcohol consumption), limited access to care (poorly controlled comorbidities, untreated viral hepatitis infections), and delay in diagnosis, and we suspect these explain the observed differences between racial groups.
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?
Studies are starting to look at the differences in chronic liver disease-related outcomes for different racial groups, however, this is most often considered a result of poorly controlled comorbidities, lifestyle, or genetic mutation. There are opportunities for improving our understanding of and our approach to disparities in two major aspects of the field of hepatology – patients in earlier stages of chronic liver disease when treatment and lifestyle modification are important, and patients with endstage liver disease being considered for transplant. In both of these areas, there is evidence suggesting social determinants are negatively affecting at-risk patient populations, and while groups have implemented changes locally (ie UCSF diagnosing and treating homeless patients with hepatitis C via a van, Northwestern scheduling Spanish-speaking patients with all Spanish-speaking staff and providers for pre-transplant evaluation), there is additional room for improvement.