Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
Curr Allergy Asthma Rep. 2020 Feb 6;20(2):5. doi: 10.1007/s11882-020-0899-6.
Using the WHO Conceptual Framework for Action on the Social Determinants of Health, this review provides a discussion of recent epidemiologic, mechanistic, and intervention studies of structural and social determinants of health and asthma outcomes covering the period from 2014 to 2019.
A majority of studies and interventions to date focus on the intermediary determinants of health (e.g., housing), which as the name suggests, exist between the patient and the upstream structural determinants of health (e.g., housing policy). Race/ethnicity remains a profound social driver of asthma disparities with cumulative risk from many overlapping determinants. A growing number of studies on asthma are beginning to elucidate the underlying mechanisms that connect social determinants to human disease. Several effective interventions have been developed, though a need for large-scale policy research and innovation remains. Strong evidence supports the key role of the structural determinants, which generate social stratification and inequity, in the development and progression of asthma; yet, interventions in this realm are challenging to develop and therefore infrequent. Proximal, intermediary determinants have provided a natural starting point for interventions, though structural interventions have the most potential for major impact on asthma outcomes. Further research to investigate the interactive effect of multiple determinants, as well as intervention studies, specifically those that are cross-sector and propose innovative strategies to target structural determinants, are needed to address asthma morbidities, and more importantly, close the asthma disparity gap.
本综述运用世界卫生组织（WHO）健康问题社会决定因素行动概念框架，讨论了 2014 年至 2019 年期间，健康和哮喘结局的结构和社会决定因素的最新流行病学、机制和干预研究。
迄今为止，大多数研究和干预措施都集中在健康的中间决定因素（如住房）上，这些因素正如其名，存在于患者和健康的上游结构决定因素（如住房政策）之间。种族/民族仍然是哮喘差异的一个深刻的社会驱动因素，许多重叠的决定因素造成了累积风险。越来越多的关于哮喘的研究开始阐明将社会决定因素与人类疾病联系起来的潜在机制。已经开发出一些有效的干预措施，但仍需要进行大规模的政策研究和创新。有强有力的证据表明，产生社会分层和不平等的结构决定因素在哮喘的发展和进展中起着关键作用；然而，这一领域的干预措施很难开发，因此也很少实施。近端中间决定因素为干预措施提供了一个自然的起点，尽管结构性干预措施最有潜力对哮喘结局产生重大影响。需要进一步研究来调查多个决定因素的相互作用，以及干预研究，特别是那些跨部门的研究，并提出针对结构性决定因素的创新策略，以解决哮喘发病率问题，更重要的是，缩小哮喘差异差距。
