Department of Neurology, Comprehensive Center for Brain Health, University of Miami, Boca Raton, Florida, United States of America.
Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America.
PLoS One. 2024 Nov 18;19(11):e0313625. doi: 10.1371/journal.pone.0313625. eCollection 2024.
Researchers have increasingly recognized the importance of structural and social determinants of health (SSDOH) as key drivers of a multitude of diseases and health outcomes. The Multi-Ethnic Study of Atherosclerosis (MESA) is an ongoing, longitudinal cohort study of subclinical cardiovascular disease (CVD) that has followed geographically and racially/ethnically diverse participants starting in 2000. Since its inception, MESA has incorporated numerous SSDOH assessments and instruments to study in relation to CVD and aging outcomes. In this paper, we describe the SSDOH data available in MESA, systematically review published papers using MESA that were focused on SSDOH and provide a roadmap for future SSDOH-related studies.
The study team reviewed all published papers using MESA data (n = 2,125) through January 23, 2023. Two individuals systematically reviewed titles, abstracts, and full text to determine the final number of papers (n = 431) that focused on at least one SSDOH variable as an exposure, outcome, or stratifying/effect modifier variable of main interest (discrepancies resolved by a third individual). Fifty-seven percent of the papers focused on racialized/ethnic groups or other macrosocial/structural factors (e.g., segregation), 16% focused on individual-level inequalities (e.g. income), 14% focused on the built environment (e.g., walking destinations), 10% focused on social context (e.g., neighborhood socioeconomic status), 34% focused on stressors (e.g., discrimination, air pollution), and 4% focused on social support/integration (e.g., social participation). Forty-seven (11%) of the papers combined MESA with other cohorts for cross-cohort comparisons and replication/validation (e.g., validating algorithms).
Overall, MESA has made significant contributions to the field and the published literature, with 20% of its published papers focused on SSDOH. Future SSDOH studies using MESA would benefit by using recently added instruments/data (e.g., early life educational quality), linking SSDOH to biomarkers to determine underlying causal mechanisms linking SSDOH to CVD and aging outcomes, and by focusing on intersectionality, understudied SSDOH (i.e., social support, social context), and understudied outcomes in relation to SSDOH (i.e., sleep, respiratory health, cognition/dementia).
研究人员越来越认识到健康的结构性和社会性决定因素（SSDOH）作为多种疾病和健康结果的关键驱动因素的重要性。动脉粥样硬化多民族研究（MESA）是一项正在进行的、针对亚临床心血管疾病（CVD）的纵向队列研究，从 2000 年开始对地理位置和种族/族裔多样化的参与者进行跟踪。自成立以来，MESA 已经纳入了许多 SSDOH 评估和工具，以研究与 CVD 和衰老结果的关系。在本文中，我们描述了 MESA 中可用的 SSDOH 数据，系统地回顾了使用 MESA 数据的已发表论文，并为未来与 SSDOH 相关的研究提供了路线图。
研究团队通过 2023 年 1 月 23 日审查了所有使用 MESA 数据的已发表论文（n=2125）。两名研究人员系统地审查了标题、摘要和全文，以确定最终的论文数量（n=431），这些论文至少关注一个 SSDOH 变量作为主要感兴趣的暴露、结局或分层/效应修饰变量（分歧由第三名研究人员解决）。57%的论文关注种族化/族裔群体或其他宏观社会/结构性因素（例如，隔离），16%的论文关注个体层面的不平等（例如收入），14%的论文关注建筑环境（例如，步行目的地），10%的论文关注社会环境（例如，邻里社会经济地位），34%的论文关注压力源（例如歧视、空气污染），4%的论文关注社会支持/整合（例如社会参与）。47%（11%）的论文将 MESA 与其他队列相结合进行跨队列比较和复制/验证（例如，验证算法）。
总体而言，MESA 为该领域和已发表文献做出了重大贡献，其 20%的已发表论文都集中在 SSDOH 上。未来使用 MESA 进行 SSDOH 研究将受益于使用最近添加的工具/数据（例如，早期教育质量），将 SSDOH 与生物标志物联系起来，以确定 SSDOH 与 CVD 和衰老结果之间的潜在因果机制，并关注交叉性、研究不足的 SSDOH（即社会支持、社会环境）以及与 SSDOH 相关的研究不足的结果（即睡眠、呼吸健康、认知/痴呆）。
