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. 2022 Nov;130(11):116001.
doi: 10.1289/EHP11015. Epub 2022 Nov 9.

Assessing How Social Exposures Are Integrated in Exposome Research: A Scoping Review

Lola Neufcourt  1 , Raphaële Castagné  1 , Laurence Mabile  1 , Saman Khalatbari-Soltani  2   3 , Cyrille Delpierre  1 , Michelle Kelly-Irving  1   4
Affiliations

Assessing How Social Exposures Are Integrated in Exposome Research: A Scoping Review

Lola Neufcourt et al. Environ Health Perspect. 2022 Nov.

Abstract

Background: Exposome research aims to describe and understand the extent to which all the exposures in human environments may affect our health over the lifetime. However, the way in which humans interact with their environment is socially patterned. Failing to account for social factors in research exploring the exposome may underestimate the magnitude of the effect of exposures or mask inequalities in the distribution of both exposures and outcomes.

Objectives: We aimed to describe the extent to which social factors appear in the exposome literature, the manner in which they are used in empirical analyses and statistical modeling, and the way in which they are considered in the overall scientific approach.

Methods: We conducted a scoping review of the literature using three databases (PubMed, Embase, and Web of Science) up to January 2022. We grouped studies based on the way in which the social variables were used in the analyses and quantified the type and frequency of social variables mentioned in the articles. We also qualitatively described the scientific approach used by authors to integrate social variables.

Results: We screened 1,001 records, and 73 studies were included in the analysis. Fifty-five (∼75%) used social variables as exposures or confounders or both, and a wide array of social variables were represented in the articles. Individual-level social variables were more often found, especially education and race/ethnicity, as well as neighborhood-level deprivation indices. Half of the studies used a hypothesis-free approach and the other half, a hypothesis-driven approach. However, in the latter group, of 35 studies, only 8 reported and discussed at least one possible social mechanism underlying the relationship observed between the social variable and the outcome.

Discussion: Social factors in exposome research should be considered in a more systematic way, considering their role in structuring both the specific external and the internal exposome. Doing so could help to understand the mechanisms of construction and, potentially, alleviate social inequalities in health and mitigate the emergence of new ones. https://doi.org/10.1289/EHP11015.

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Figures

Figure 1 is a typography word cloud displaying the following words: Health care insurance, Maternal education, Race-ethnicity, Single parent household, Migration status, Rural or Urban, Race-ethnicity, Access to facilities, House crowding, Segregation, Family social network, Family Social participation, Working conditions, Education, Country of birth, Parental adverse life events, Verbal discrimination, Food (in)security, Family adversity index, Parental education, Household income, Occupation, Neighborhood security, Literacy, Poverty, Maternal migration status, Paternal ethnicity, Paternal occupation, Income, Paid child care, Rural or Urban, Housing, Parental country of birth, Maternal ethnicity, Maternal occupation, Occupation, Family structure, Housing, Social support, Household size, Maternal education, Family financial hardship, Household SES, Social engagement, Psychosocial factors, Maternal health insurance, Paternal education, Paternal S E S, Family S E S, Individual S E S, vulnerable populations, Financial constraint in access to care, Wealth, Traumatic life experiences, House Crowding, Maternal employment, Paternal employment, Maternal stress, Maternal social class, Wealth, Food security, Violence, Linguistic isolation, Childhood adversity, Family affluence score, Family social contacts, Social contact, Social support, Social capital, Spouse’s education, Household wealth, Government support, Public housing, Education, Employment status, Poverty, Neighborhood S E S, Employment, and Income. The typography is categorized into four groups of social variables, namely, Area or level characteristics, Family or household characteristics, individual characteristics, and parental characteristics.
Figure 1.
Word cloud of the social variables used in the selected articles. Detailed table is available in Table S3. Note: SES, socioeconomic status.
Figure 2 is a flowchart with three steps. Step 1: 73 articles included in the analysis leads to 36 articles that is 49 percent of Agnostic approach, 35 articles that is 48 percent of Hypothesis-driven approach, and 2 articles that is 3 percent of mixed approach. Step 2: Agnostic approach group of articles is subdivided as: 20 articles using classical agnostic approach and 16 articles mentioning social features. Hypothesis-driven approach group of articles is subdivided as 12 articles mentioning social hypothesis (introduction) and 23 articles mentioning no social hypothesis. Step 3: The group of 12 articles mentioning social hypothesis in introduction is subdivided as: 7 articles discussing social mechanism (discussion) and 5 articles discussing no social mechanism. The group of twenty-three articles mentioning no social hypothesis is subdivided into 1 article discussing social mechanism (discussion) and 22 articles discussing no social mechanism.
Figure 2.
Social environment, a priori hypotheses and underlying mechanisms. Detailed table is available in Table S4. Note: Agnostic approach, data exploration with no predefined hypothesis of interest; hypothesis-driven approach, test of an explicit hypothesis about the relationship between exposure(s) and outcome(s).
Figure 3 is a flowchart with six steps. Step 1: Are you using social variables in your exposure research? Exposures: Yes, I am using social variables as exposures and Confounders: Yes, I am using social variables as confounding factors. Step 2: Exposures: Yes, I am using social variables as exposures leads to Does your analysis aim to be agnostic, without any a priori hypothesis, or are you testing hypotheses? and Confounders: Yes, I am using social variables as confounding factors leads to Does your analysis aim to adjust for potential spurious results caused by social variables being associated with your exposure and outcome? Step 3: Does your analysis aim to be agnostic, without any a priori hypothesis, or are you testing a hypothesis? leads to Agnostic: hypothesis generating: Advantages include to explore the data and to generate potentially new hypotheses to investigate. Disadvantages include the hierarchical relationships between structural social factors, downstream social factors and exposures are not considered, and Hypothesis testing: Advantages includes explicitly test social exposures are related to biological and or health outcomes. Disadvantages include several hypotheses that cannot be tested at the same time. Step 4: Does your analysis aim to adjust for potential spurious results caused by social variables being associated with your exposure and outcome? leads to Advantages include to account for a social variable that influences both the exposure and outcome variables in an analysis, potentially causing spurious results. Disadvantages include Researchers may be tempted to interpret the effect of the confounding variable on the outcome. Step 5: Recommended questions to ask when testing hypotheses: What mechanisms might underlie the hypothesis about how a social variable relates to biological or health outcomes (compare Bartley)? leads to Behavioral, Material, and Psychosocial. Step 6: Behavioral: Do the social variables relate to different health behaviors, such as smoking, drinking, food preferences, exercise, etc? Material: Do the social variables relate to physical and chemical exposures due to housing conditions, occupational or exposures in the place of residence? Psychosocial: Do the social variables relate to stressors such as adverse childhood experiences (A C Es), discrimination, job stress, etc?
Figure 3.
Recommendations regarding the use of social variables in the exposome context.
See this image and copyright information in PMC

Comment in

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