Research Topicsin Social Epidemiology

Laura Rudkin, Ph.D.Division of Sociomedical SciencesDepartment of Preventive Medicine

& Community Health

General Purposes of Epidemiology To describe To explain To predict To control

General Purposes of Social Epidemiology To describe social differentials in health

outcomes. To explain the observed social differentials by

identifying causal mechanisms. To predict how policy changes and

psychosocial interventions might reduce the differentials.

To control and improve population health.

Identifying, Investigating Social Differentials in Health Outcomes

Social Factors•SES•Race/Ethnicity•Gender•Age, Life Course•Place, Environment

Health Outcomes•Mortality•Morbidity•Disability•Well-being

Identifying, Investigating Social Differentials in Health Outcomes

Social Factors•SES•Race/Ethnicity•Gender•Age, Life Course•Place, Environment

Health Outcomes•Mortality•Morbidity•Disability•Well-being

Health Behaviors

Psychosocial Stressors and

Resources

Physical Environmental

Stressors

Health Care Access,

Utilization,and Quality

Social Factors

Socioeconomic statusEducation, income, occupation

Wealth

Childhood SES

Community SES

Social relationshipsSocial support

Social networks

Social isolation

Social engagement

Social Factors

Occupational factorsDemand-control

Effort-reward imbalance

Social inequalitiesRace, ethnicity

Nativity status

Gender

Sexual orientation

Religious belief, affiliation

Sources of Heterogeneity

Reverse causalitySelective drift

Differential susceptibilitySpurious relationship, third variable is causal

Individual lifestyleHealth-related behaviors

Sources of Heterogeneity

Physical environmentHarmful exposures to physical, chemical, biological agents

Social environment & psychological responseStressors, social & coping resources

Health care servicesDifferential access, quality, utilization

Williams, 1997

Basic v. surface causes

Basic causesDistal causes, also called fundamental causes

Work through multiple pathways, affect multiple outcomes

What puts people at risk for risk?

Surface causesProximal causes, traditional risk factors

FIGURE 1. Conceptual framework for the relation between socioeconomic position and health among persons with diabetes mellitus. Numbers and letters refer to pathways mentioned in the text. From:   Brown: Epidemiol Rev, Volume 26(1).July 2004.63-77

FIGURE 2. Distal mediators and moderators of the relation between socioeconomic position and health behaviors, access to care, processes of care, and health among persons with diabetes mellitus. From:   Brown: Epidemiol Rev, Volume 26(1).July 2004.63-77

Direct & Buffering EffectsDirect & Buffering Effectsof Social Supportof Social Support

STRESSOR APPRAISAL COPINGHEALTH

OUTCOMES

•SOCIAL SUPPORT•Instrumental•Emotional•Informational•Appraisal

•Stressors may activate social support•Social support may reduce stressors

Buffering effects

Direct effect

Social Position

SocialEnvironment

SocialInteraction

Perceptionsof Injustice

NegativeEmotionalResponse

High Allostatic Load

Poor Health Outcomes

Genetic Endowment

Development

Daily Life

•Personal•Productive•Societal

Social Structure

FIGURE 2. Upstream and downstream determinants of population health. Reprinted with permission from Promoting Health: Intervention Strategies from Social and Behavioral Research, by the National Academy of Sciences. Courtesy of the National Academies Press, Washington, DC. From:   Kaplan: Epidemiol Rev, Volume 26(1).July 2004.124-135

Underlying Assumptions

Biological, behavioral, social factors interact through multiple feedback mechanisms to influence individual health over time.

Interactions often bidirectional, so cause-and-effect models, used alone, likely to misrepresent actual relationships.

Underlying Assumptions

Because health is a function of biological, psychological, social variables, many events, interventions traditionally considered irrelevant actually are quite important for health status of individuals, populations.