From the Outside In: Biological Mechanisms Linking Social and Environmental Exposures to Chronic Disease and to Health Disparities
From the Outside In: Biological Mechanisms Linking Social and Environmental Exposures to Chronic Disease and to Health Disparities
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DOI：
10.2105/ajph.2018.304864
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发表时间：
2019-01-01
影响因子：
12.7
通讯作者：
Rajapakse, Nishadi
中科院分区：
文献类型：
--
作者：
Bagby, Susan P.;Martin, Damali;Rajapakse, Nishadi
慢性疾病的持续流行涉及一系列临床实体，现在被理解为代表生命早期开始的进行性代谢功能障碍的晚期表现。这些疾病不成比例地影响弱势群体，加剧了尽管公共卫生努力仍存在的健康差距。过度暴露于紧张的社会心理和环境力量是已知造成高危环境中人口水平差异的一个因素。然而，越来越多的证据表明，即使是一次不利的环境暴露，特别是在发育的早期，也可能成为生物学上的固有因素，诱发长期的疾病促进途径，放大对未来所有不利压力源的反应（例如皮质醇、免疫、炎症），从而增强其疾病促进作用。同样的途径也可能与祖先相关的遗传变异相互作用，从而改变慢性疾病的风险。在高危人群中，环境激活的疾病促进途径如何促成基于生物学的疾病易感表型；这在有多种不良接触的人群中可能具有独特的破坏性，并且能够跨代传播。这一生物学观点旨在补充现有模式，强调了有可能加强减少健康差距的关键研究机会和生命阶段优先事项。
The ongoing epidemic of chronic diseases involves a spectrum of clinical entities now understood to represent late manifestations of progressive metabolic dysfunction initiated in early life. These diseases disproportionately affect disadvantaged populations, exacerbating health disparities that persist despite public health efforts.Excessive exposure to stressful psychosocial and environmental forces is 1 factor known to contribute to population-level disparities in at-risk settings. Yet increasing evidence reveals that even a single adverse environmental exposure-especially during very early developmental years-can become literally biologically embedded, inducing long-lasting disease-promoting pathways that amplify responses (e.g., cortisol, immune, inflammatory) to all future adverse stressors, thusenhancing their disease-promoting impacts. The same pathways may also interact with ancestrally linked genetic variants to modify chronic disease risk.We address how, in at-risk populations, environmentally activated disease-promoting pathways can contribute to a biologically based disease-susceptible phenotype; this is likely to be uniquely damaging in populations with multiple adverse exposures and is capable of cross-generational transmission. Intended to complement existing models, this biological perspective highlights key research opportunities and life-stage priorities with potential to enhance the reduction of health disparities.