Szaflarski Magdalena
Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
Epilepsy Behav. 2014 Dec;41:283-9. doi: 10.1016/j.yebeh.2014.06.013. Epub 2014 Jul 4.
Social factors have been identified as key drivers of epilepsy care, outcomes, and disparities, but there is a limited understanding of what these factors are and how they translate into disparities. This targeted review provides an overview of the social determinants of health framework and applies this perspective to the literature about social and psychosocial factors in epilepsy; a social determinants of health--epilepsy model is proposed. The key social determinants of health in epilepsy include socioeconomic status, race/ethnicity, age, and gender. For example, low socioeconomic status and minority status have been associated with a higher risk of epilepsy, more hospitalizations and emergency room visits (versus neurology services), antiepileptic drug nonadherence, and a lower rate of epilepsy surgery. Such differences in care/treatment and outcomes translate into health disparities, many of which are considered unjust (inequitable) and modifiable through social action. Other social determinants of health include structural and sociocultural contextual conditions (e.g., health economy, policy, and social stigma/discrimination) and mediating mechanisms including material (e.g., housing), behavioral/biological (e.g., adherence), psychosocial (e.g., perceived stigma), and health system (e.g., access) factors. There are complex relationships among social determinants of health in epilepsy, which remain poorly understood and hamper efforts to address and eliminate disparities in epilepsy care and outcomes. Further empirical work grounded in sound theory and robust methodologies is needed to identify points of intervention and design effective and socially acceptable solutions to any pervasive disparities in epilepsy.
社会因素已被确定为癫痫护理、治疗结果及差异的关键驱动因素，但对于这些因素是什么以及它们如何转化为差异的理解有限。本专题综述概述了健康的社会决定因素框架，并将这一视角应用于有关癫痫社会和心理社会因素的文献；提出了一个健康的社会决定因素——癫痫模型。癫痫中健康的关键社会决定因素包括社会经济地位、种族/民族、年龄和性别。例如，社会经济地位低下和少数群体身份与癫痫风险较高、住院和急诊就诊次数较多（相对于神经科服务）、抗癫痫药物治疗依从性差以及癫痫手术率较低有关。护理/治疗和结果方面的这些差异转化为健康差异，其中许多差异被认为是不公平的（不平等的），可通过社会行动加以改变。其他健康的社会决定因素包括结构性和社会文化背景条件（如卫生经济、政策和社会耻辱/歧视）以及中介机制，包括物质（如住房）、行为/生物（如依从性）、心理社会（如感知到的耻辱）和卫生系统（如可及性）因素。癫痫中健康的社会决定因素之间存在复杂的关系，目前对此仍知之甚少，这阻碍了消除癫痫护理和治疗结果差异的努力。需要开展更多基于可靠理论和强大方法的实证研究，以确定干预点，并设计有效且为社会所接受的解决方案，来解决癫痫中普遍存在的差异问题。
