Consigned to Illness: Individual and Community Models of Socioeconomic Status and Health

Award Year:
Ed Yelin
Population Health, Social Determinants of Health
The observation that persons of low socioeconomic status (SES) experience poorer health outcomes has been an important focus of research and health policy for several decades, but the gap has not narrowed during this time. The purpose of the Investigator Award is to conduct research to understand how individual- and community-level SES affect health care and long-term outcomes to improve the specificity of policies to address this issue. The research project takes advantage of a large-scale national study of 1,300 persons with a severe autoimmune disease, systemic lupus erythematosus (SLE), who have been followed for 15 years in the Lupus Outcomes Study (LOS). The LOS includes data from genetic and traditional laboratory assays, annual structured interviews, and information about participants’ communities. The research will involve quantitative analysis of LOS data to study the relationship among individual- and community-level SES, health care, and long-term outcomes, as well as qualitative analysis of key informant interviews and focus groups to understand why some individuals of low SES are able to defy the odds of poor outcomes and some communities with large concentrations of the poor are able to help their residents buffer the effects of low SES. The LOS data permit an investigation of the potential impact of intervening at various points on a continuum from the sub-cellular level of the individual to the community at large, and also allow intensive study of severe medical condition debates in the policy community about the appropriate locus for initiatives to reduce disparities. The product of this work will be a series of medical and social science publications, plus a book, tentatively titled, Consigned to Illness, that will describe the overriding strength of individual- and community-level SES in health outcomes, as well as outline policy initiatives that may limit their effect.