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Social Determinants of Treatment Response. Am J Med 2018 May;131(5):480-483

Date

02/09/2018

Pubmed ID

29421690

DOI

10.1016/j.amjmed.2018.01.019

Scopus ID

2-s2.0-85042633046 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

Socioeconomic status is consistently linked to population health and specifically to the finding that there is decreasing health associated with decreasing social position. Despite the substantial literature, an analogous literature that is focused on clinical practice, and especially consideration of the individual, is almost nonexistent. Even in the absence of these data, physicians routinely incorporate patient life experience (biography) into their estimation of a patient's clinical trajectory (prognosis) and when making therapeutic decisions. Some advances have occurred that strengthen the evidence base, such as the US Food and Drug Administration decision to show all results from randomized controlled trials on newly approved drugs by age, sex, and race. In this article we review the current status of research on the impact of social determinants of treatment response and illustrate the important role of the therapeutic context in both research and practice. Examples are provided in which a patient's "biography" alters treatment response in subgroups of the population studied. We also provide examples in which multi-omic data and biographical information in a single individual can illuminate the clinical expression of disease. Finally, we suggest a research agenda that would better support physicians who use social and behavioral features as important elements in their decision making in clinical care.

Author List

Bachur C, Singer B, Hayes-Conroy A, Horwitz RI

Author

Catherine Bachur MD, MA Maternal Fetal Medicine Fellow in the Obstetrics and Gynecology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Health Behavior
Humans
Precision Medicine
Social Class
Social Determinants of Health
Social Environment