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. 2023 Feb 24;192(3):475-482.
doi: 10.1093/aje/kwac186.

Exposure, Susceptibility, and Recovery: A Framework for Examining the Intersection of the Social and Physical Environments and Infectious Disease Risk

Grace A Noppert  1 , Sonia T Hegde  2 , John T Kubale  3
Affiliations

Exposure, Susceptibility, and Recovery: A Framework for Examining the Intersection of the Social and Physical Environments and Infectious Disease Risk

Grace A Noppert et al. Am J Epidemiol. .

Abstract

Despite well-documented evidence that structurally disadvantaged populations are disproportionately affected by infectious diseases, our understanding of the pathways that connect structural disadvantage to the burden of infectious diseases is limited. We propose a conceptual framework to facilitate more rigorous examination and testing of hypothesized mechanisms through which social and environmental factors shape the burden of infectious diseases and lead to persistent inequities. Drawing upon the principles laid out by Link and Phelan in their landmark paper on social conditions (J Health Soc Behav. 1995;(spec no.):80-94), we offer an explication of potential pathways through which structural disadvantage (e.g., racism, sexism, and economic deprivation) operates to produce infectious disease inequities. Specifically, we describe how the social environment affects an individual's risk of infectious disease by 1) increasing exposure to infectious pathogens and 2) increasing susceptibility to infection. This framework will facilitate both the systematic examination of the ways in which structural disadvantage shapes the burden of infectious disease and the design of interventions that can disrupt these pathways.

Keywords: communicable diseases; disease susceptibility; disease transmission; racism; social environment; socioeconomic factors; vectorborne diseases; waterborne diseases.

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Figures

Figure 1
Figure 1
Conceptual framework illustrating the hypothesized mechanisms through which structural disadvantage, as defined by racism, sexism, and economic disadvantage, increases the frequency and intensity of exposure to infectious pathogens. The conceptual framework for this pathway is described at both the structural level (depicted in light gray) and the individual level (depicted in darker gray).
Figure 2
Figure 2
Conceptual framework illustrating the hypothesized mechanisms through which structural disadvantage, as defined by racism, sexism, and economic disadvantage, increases the likelihood that an individual will contract a disease given exposure to an infectious pathogen. The conceptual framework for this pathway is described at both the structural level (depicted in light gray) and the individual level (depicted in darker gray).
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References

    1. Noppert GA, Kubale JT, Wilson ML. Analyses of infectious disease patterns and drivers largely lack insights from social epidemiology: contemporary patterns and future opportunities. J Epidemiol Community Health. 2017;71(4):350–355. - PMC - PubMed
    1. Hong B, Bonczak BJ, Gupta A, et al. Exposure density and neighborhood disparities in COVID-19 infection risk. Proc Natl Acad Sci U S A. 2021;118(13):e2021258118. - PMC - PubMed
    1. Noppert GA, Wilson ML, Clarke P, et al. Race and nativity are major determinants of tuberculosis in the U.S.: evidence of health disparities in tuberculosis incidence in Michigan, 2004–2012. BMC Public Health. 2017;17(1):538. - PMC - PubMed
    1. Lieberman-Cribbin W, Tuminello S, Flores RM, et al. Disparities in COVID-19 testing and positivity in New York City. Am J Prev Med. 2020;59(3):326–332. - PMC - PubMed
    1. Chakaya J, Khan M, Ntoumi F, et al. Global Tuberculosis Report 2020—reflections on the global TB burden, treatment and prevention efforts. Int J Infect Dis. 2021;113(suppl 1):S7–S12. - PMC - PubMed

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