Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities
Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities
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DOI：
10.1093/ije/dyy167
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发表时间：
2019-02-01
影响因子：
7.7
通讯作者：
Whitehead, Margaret
中科院分区：
文献类型：
--
作者：
Diderichsen, Finn;Hallqvist, Johan;Whitehead, Margaret
本文讨论了脆弱性和易感性的概念及其与理解和解决健康不平等的相关性。解决健康方面的社会经济不平等问题的基础是了解个人的社会地位如何影响疾病风险。从概念上讲，有两种可能的机制（不是相互排斥的）：要么是某些疾病的原因在社会经济群体中分布不均匀（不同的暴露），要么是某些疾病的原因对不同群体的影响不同（不同的影响）。由于差异的脆弱性和易感性往往是用来表示后者，我们讨论这些概念和它们目前的使用，并提出了流行病学相关的区别。因此，社会地位的影响可以通过在社会群体中分布不均匀和/或与社会地位相互作用的原因来调节。最近改进的方法来估计调解和相互作用，使人们有可能计算措施的相关性，制定目标和优先事项的政策，包括健康公平的两种机制，即平等的接触或平等的影响。最后，我们讨论了不同的易感性和脆弱性的预防策略，包括针对高风险的个人，整个人口和弱势群体的方法的选择的重要性。
This paper discusses the concepts of vulnerability and susceptibility and their relevance for understanding and tackling health inequalities. Tackling socioeconomic inequalities in health is based on an understanding of how an individual's social position influences disease risk. Conceptually, there are two possible mechanisms (not mutually exclusive): there is either some cause(s) of disease that are unevenly distributed across socioeconomic groups (differential exposure) or the effect of some cause(s) of disease differs across groups (differential effect). Since differential vulnerability and susceptibility are often used to denote the latter, we discuss these concepts and their current use and suggest an epidemiologically relevant distinction. The effect of social position can thus be mediated by causes that are unevenly distributed across social groups and/or interact with social position. Recent improvements in the methodology to estimate mediation and interaction have made it possible to calculate measures of relevance for setting targets and priorities in policy for health equity which include both mechanisms, i.e. equalize exposure or equalize effects. We finally discuss the importance of differential susceptibility and vulnerability for the choice of preventive strategies, including approaches that target high-risk individuals, whole populations and vulnerable groups.