The health outcome of interest for me is impact of non-clinical factors such as SES and health disparities on clinical outcomes in patients undergoing treatment for bladder cancer.
A structural factor is income. While income was noted to have a “dose-response” association with health, further granularity may better elucidate the impact of disposable income compared to gross income. While gross income gives a more global view of the earnings coming into the household, it provides little information on how the income is allocated with regards to the financial responsibilities of the family and health selection. Income also affects the level of formal education generally obtainable within the neighborhood or community.
A 2nd structural factor is occupation. Occupation not only reflects social standing but also plays a key role in exposures (occupation-related) and gross income. This may influence access to health care, insurance options available and the types of life stressors present. Occupation and its relationship with both health access and education also set the tone for subsequent generations; either bolstering or weakening barriers to improved health.
One intermediary factor is behavioral factors. Behaviors such as smoking are known to be directly related to risk of bladder cancer. Social inequalities are related to differences in lifestyle and rates of risky behavior. The accumulation of repeated insults or damaging behavior also ties into the incidence of disease in the population and magnitude of life stressors.
2) Socioeconomic factors earlier in life and neighborhood characteristics may increase the risk of bladder cancer and oncologic outcomes after treatment. A lack of health-related knowledge/literacy and poor education may decrease the likelihood of an impactful relationship with healthcare providers. This in turn will increase the risk of lifelong exposure to risky behavior (such as smoking or exposure to 2nd hand smoke) and missed opportunities for early diagnosis and management (such as evaluation at the first instance of hematuria). Poverty may lead to an increase in cumulative negative effects on health and the lack of childhood health literacy/knowledge. The authors postulate that childhood SES influences adult health, though the relative importance remains unclear. Lack of neighborhood/regional resources only further exacerbates the issue.