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Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities.
International Journal of Epidemiology ( IF 7.7 ) Pub Date : 2019-02-01 , DOI: 10.1093/ije/dyy167
Finn Diderichsen 1, 2 , Johan Hallqvist 3 , Margaret Whitehead 4
Affiliation  

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.

中文翻译:

不同的脆弱性和易感性:如何在我们对调解和互动的理解中利用最新发展来解决健康不平等问题。

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是基于对个人社会地位如何影响疾病风险的理解。从概念上讲,有两种可能的机制(不是互斥的):要么某些疾病原因在社会经济群体中分布不均(差异暴露),要么某些疾病原因的影响在群体之间有所不同(差异性)影响)。由于经常使用差异性易感性和易感性来表示后者,因此我们讨论了这些概念及其当前用途,并提出了流行病学上的相关区分。因此,社会地位的影响可以通过在社会群体中分布不均和/或与社会地位互动的原因来介导。估计调解和互动的方法的最新改进使得有可能计算与确定卫生公平政策中的目标和优先事项相关的措施,其中包括两种机制,即均等暴露或均等作用。最后,我们讨论了敏感性和脆弱性差异对预防策略的选择的重要性,这些策略包括针对高风险个人,整个人群和弱势群体的方法。估计调解和互动的方法的最新改进使得有可能计算与确定卫生公平政策中的目标和优先事项相关的措施,其中包括两种机制,即均等暴露或均等作用。最后,我们讨论了敏感性和脆弱性差异对预防策略的选择的重要性,这些策略包括针对高风险个人,整个人群和弱势群体的方法。估计调解和互动的方法的最新改进使得有可能计算与确定卫生公平政策中的目标和优先事项相关的措施,其中包括两种机制,即均等暴露或均等作用。最后,我们讨论了敏感性和脆弱性差异对预防策略的选择的重要性,这些策略包括针对高风险个人,整个人群和弱势群体的方法。
更新日期:2019-03-01
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