Abstract
The lower an individual's socioeconomic position, the higher their risk of poor health in low-, middle-, and high-income settings alike. As health inequities grow, it is imperative that we develop an empirically-driven mechanistic understanding of the determinants of health disparities, and capture disease burden in at-risk populations to prevent exacerbation of disparities. Past work has been limited in data or scope and has thus fallen short of generalizable insights. Here, we integrate empirical data from observational studies and large-scale healthcare data with models to characterize the dynamics and spatial heterogeneity of health disparities in an infectious disease case study: influenza. We find that variation in social and healthcare-based determinants exacerbates influenza epidemics, and that low socioeconomic status (SES) individuals disproportionately bear the burden of infection. We also identify geographical hotspots of influenza burden in low SES populations, much of which is overlooked in traditional influenza surveillance, and find that these differences are most predicted by variation in susceptibility and access to sickness absenteeism. Our results highlight that the effect of overlapping factors is synergistic and that reducing this intersectionality can significantly reduce inequities. Additionally, health disparities are expressed geographically, and targeting public health efforts spatially may be an efficient use of resources to abate inequities. The association between health and socioeconomic prosperity has a long history in the epidemiological literature; addressing health inequities in respiratory-transmitted infectious disease burden is an important step towards social justice in public health, and ignoring them promises to pose a serious threat.
Highlights
Health disparities are differences in health outcomes between social groups, and they persist in all modern public health settings
Many potential causes of these inequities have been proposed, but they have not been compared, and we do not understand their population-scale impacts. Our understanding of these issues is further hindered by epidemiological surveillance, which has been shown to overlook areas of low socioeconomic
We show that low socioeconomic status individuals disproportionately bear the burden of influenza infection, and that all proposed factors are synergistic in their effect
Summary
Health disparities are differences in health outcomes between social groups, and they persist in all modern public health settings. There is a role played by geographic context: the spatial distribution of disparity in health cannot be explained by variation in social factors alone [3]. As the divide in health disparities grows wider across the world and within countries, it is imperative that we continue to understand how social determinants impact health, and how this is reflected geographically [4]. We integrate empirical insights from past studies to characterize the impact of social determinants on the dynamics and spatial heterogeneity of an infectious disease case study, influenza
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