Social determinants and the classification of disease: descriptive epidemiology of selected socially mediated disease constellations.
BACKGROUND
Most major diseases have important social determinants. In this context, classification of disease based on etiologic or anatomic criteria may be neither mutually exclusive nor optimal.


RESULTS
Units of analysis comprised large metropolitan central and fringe metropolitan counties with reliable mortality rates--(n = 416). Participants included infants and adults ages 25 to 64 years with selected causes of death (1999 to 2006). Exposures included that residential segregation and race-specific social deprivation variables. Main outcome measures were obtained via principal components analyses with an orthogonal rotation to identify a common factor. To discern whether the common factor was socially mediated, negative binomial multiple regression models were developed for which the dependent variable was the common factor. Results showed that infant deaths, mortality from assault, and malignant neoplasm of the trachea, bronchus and lung formed a common factor for race-gender groups (black/white and men/women). Regression analyses showed statistically significant, positive associations between low socio-economic status for all race-gender groups and this common factor.


CONCLUSIONS
Between 1999 and 2006, deaths classified as "assault" and "lung cancer", as well as "infant mortality" formed a socially mediated factor detectable in population but not individual data. Despite limitations related to death certificate data, the results contribute important information to the formulation of several hypotheses: (a) disease classifications based on anatomic or etiologic criteria fail to account for social determinants; (b) social forces produce demographically and possibly geographically distinct population-based disease constellations; and (c) the individual components of population-based disease constellations (e.g., lung cancer) are phenotypically comparable from one population to another but genotypically different, in part, because of socially mediated epigenetic variations. Additional research may produce new taxonomies that unify social determinants with anatomic and/or etiologic determinants. This may lead to improved medical management of individuals and populations.
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States of America.
Robert S
RS
Levine
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States of America; Department of Sociology, Tennessee State University, Nashville, TN, United States of America.
Barbara A
BA
Kilbourne
Department of Community and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America.
George S
GS
Rust
Department of Electrical Engineering and Information Technology, University of Tennessee, Knoxville, TN, United States of America.
Michael A
MA
Langston
Center for Prevention Research, Tennessee State University, Nashville, TN, United States of America.
Baqar A
BA
Husaini
Department of Political Science, Texas Tech University, Lubbock, TX, United States of America.
Lisaann S
LS
Gittner
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States of America.
Maureen
M
Sanderson
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States of America; Charles E. Schmidt College of Medicine, Department of Epidemiology, Florida Atlantic University, Boca Raton, FL, United States of America.
Charles H
CH
Hennekens
D000328:Adult; D004194:Disease / Q000145:classification* / Q000209:etiology; D004812:Epidemiologic Methods; D004813:Epidemiology / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008875:Middle Aged; D064890:Social Determinants of Health; D014481:United States