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 a pulmonary/critical care medicine fellow, and my research interests involve health disparities in patients with interstitial lung disease. There has been little research in this area with very few associations published in the literature, so my research currently is descriptive and aims to better understand how these SDH impact access to care at a tertiary care center. Many of the social determinants are relative to patients with interstitial lung disease, including both structural determinants as well as intermediary determinants. Care can involve frequent visits and testing, sometimes at a tertiary care center that is not local to the patient, as well as medications that may be expensive, so income and occupation (need to work) are relevant, though as the Braveman et al article indicates, the measurement of these variables often poses challenges when drawing conclusions. Material circumstances are relevant, especially food security, in that some of these medications lead to significant weight gain and other lead to adverse GI effects that are worsened if not taken with food. The majority of these possible associations have not been reported, however, and are only hypothesized by myself as relevant. Many of these factors are likely intergenerational.
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?
The majority of both structural and intermediary determinants are relevant when studying patients with interstitial lung disease, though very few have been examined in the literature (as the primary predictor, as Braveman et al describes). Most have focused on differences in race and ethnicity, and others have focused on access to lung transplantation. Because of this, there is much more that needs to be characterized and better understood in these patients with interstitial lung disease, and from my review of the literature, studies have not been approached with an emphasis on a socioecological framework.