lecture2
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 interested in examining access to transplant among adolescents with chronic kidney disease, and specifically how transplant access is affected by pre-transplant adherence. Adherence is a somewhat nebulous concept and adherence as it relates specifically to transplant access among pediatric populations has not been well studied. However, social determinants have been studied in pediatric patients with chronic kidney disease. The CKiD study, which I will be using in my research, is a multicenter observational prospective cohort study of children ages 1-16 years at study entry with chronic kidney disease. Sociodemographic data collected by CKiD includes race, ethnicity, household income, maternal education level, and zip code. Access to transplant, and particularly preemptive transplant (transplant before dialysis), has been shown to be affected by all of these socioeconomic factors. Children in the CKiD study who received a preemptive renal transplant on average had higher household income and higher maternal education level.1 Additionally, black children are about half as likely to receive a preemptive transplant when compared to white children.2
2. Write a brief paragraph describing the extent to which an 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?
Socioecologic factors are well recognized to affect outcomes among pediatric transplant patients. However, addressing these issues has, unsurprisingly, been challenging. Despite a large amount of research examining disparities in transplant access, research on how to best address these disparities is lacking. Additionally, very little research has been done that examines how adherence affects transplant access and how socioecologic factors affect adherence. I hope to address these issues in my future research.
1. Atkinson MA, Roem JL, Gajjar A, Warady BA, Furth SL, Muñoz A. Mode of initial renal replacement therapy and transplant outcomes in the chronic kidney disease in children (CKiD) study. Pediatric Nephrology. 2019:1-7.
2. Ng DK, Moxey-Mims M, Warady BA, Furth SL, Muñoz A. Racial differences in renal replacement therapy initiation among children with a nonglomerular cause of chronic kidney disease. Annals of epidemiology. 2016;26(11):780-787. e781.