Soweto Syndemics: A Two-Phase Study of Surveillance and Co-Morbid Experiences

这项拟议中的研究将是第一次在脆弱人群中检验传染病理论。的 与流行病概念相比，传染病概念提供了一种创新的理论和实践方法， 一种结合“协同”和“流行病”概念的方法，以研究社会、政治和生态如何 这些因素在人口一级促进疾病聚集，在个人一级影响疾病病理。 流行病的概念包含三个核心概念：1）两种或两种以上的疾病聚集在一起， 2）这些疾病相互作用，通常是生物学上的，3）大规模的社会力量促使它们发生。 南非黑人中2型糖尿病（T2DM）的综合征群违背了综合征的概念， 对这一现象的深入调查将提供重要的政策和临床观点。T2DM是 在低收入和中等收入国家的低收入人群中不断升级，T2DM影响着人们 年龄小于60岁且经常未被诊断。同时发生的情况，包括抑郁症， 这一现象很常见，尤其是居住在资源匮乏环境中的妇女。拟议的研究将 招募5，000人参加一项已建立的监测研究，以建立一个研究流行病学集群的平台。 第一个目标是通过评估产生疾病流行的社会和经济因素来检验疾病流行理论 从该监测中，发现了T2DM的集群，包括高血压（HTN）、抑郁症、HIV和结核病（TB 平台我们假设，共同发生的条件的社会和经济决定因素将不同于那些 这些决定因素促进了除了综合症集群之外的单一疾病。第二个目标将采用混合 方法对150名老年人的社会、医疗经历和保健行为进行调查， T2DM和同时发生的HTN、HIV、TB或抑郁症，以检查哪些社会和生物学经历 描述这些症状群。我们假设，独特的社会，经济，心理， 个人经历将使经历一种症状群的人与经历另一种症状群的人相比受到折磨。这些数据将 在南非目前正在进行的新的初级保健系统的规划阶段， 我们预计，对综合初级保健的见解将是及时的，相关的，和翔实的。公众 这项研究对健康的影响是：1）证明使用一个流行病学框架比一个 单一的疾病框架，以评估复杂的疾病事件，2）告知社会政策，如新的 南非的含糖饮料税，以及3）为综合初级保健提供有针对性的信息 可以为正在进行的南非卫生系统的重组提供信息。一体化临床设计 干预措施以及支持进一步研究综合征的初步研究将有更广泛的 适用于美国的临床护理和其他综合症。

The proposed research will be the first to test the theory of syndemics among a vulnerable population. The syndemics concept, in contrast to the epidemics concept, provides an innovative theoretical and practical approach that combines concepts of “synergy” with “epidemic” to investigate how social, political, and ecological factors promote disease clustering at the population-level and impact disease pathologies at the individual-level. The notion of syndemic incorporates three core concepts: 1) two or more diseases cluster together within a population, 2) these diseases interact, often biologically, and 3) large-scale social forces precipitate them. Syndemic clusters with Type 2 diabetes (T2DM) among black South Africans exemplify the syndemics concept, and in-depth investigation of this phenomenon will provide important policy and clinical perspectives. T2DM is escalating among low-income populations in low- and middle-income countries, with T2DM affecting people younger than 60 years of age and often going undiagnosed. Co-occurring conditions, including depression, are common and afflict women disproportionately residing in low-resource settings. The proposed research will recruit 5,000 individuals enrolled in an established surveillance study to create a platform to syndemic clusters. The first aim will test syndemic theory by evaluating the social and economic factors that produce syndemic clusters of T2DM, with hypertension (HTN), depression, HIV, and tuberculosis (TB), from that surveillance platform. We hypothesize that social and economic determinants of co-occurring conditions will differ from those determinants that foster singular diseases apart from syndemic clusters. The second aim will employ mixed methods to investigate the social and medical experiences and health care behaviors among 150 people with T2DM and co-occurring HTN, HIV, TB, or depression to examine what social and biological experiences characterize these syndemic clusters. We hypothesize that unique social, economic, psychological, and personal experiences will afflict people experiencing one syndemic cluster compared to another. These data will be imperative during the planning stages of the new primary care system currently underway in South Africa, and we anticipate that insights into integrated primary care will be timely, relevant, and informative. The public health impact of this research is to 1) demonstrate that using a syndemics framework is more effective than a singular disease framework to evaluate complicated disease events, 2) inform social policy, such as the new sugar sweetened beverage tax in South Africa, and 3) provide targeted information for integrated primary care that can inform the restructuring of the South African health system underway. The design of integrated clinical interventions as well as the preliminary research to support further research on syndemics will have broader applicability to clinical care in the U.S. and other syndemic conditions.