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      Sociomarkers and biomarkers: predictive modeling in identifying pediatric asthma patients at risk of hospital revisits

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          Abstract

          The importance of social components of health has been emphasized both in epidemiology and public health. This paper highlights the significant impact of social components on health outcomes in a novel way. Introducing the concept of sociomarkers, which are measurable indicators of social conditions in which a patient is embedded, we employed a machine learning approach that uses both biomarkers and sociomarkers to identify asthma patients at risk of a hospital revisit after an initial visit with an accuracy of 66%. The analysis has been performed over an integrated dataset consisting of individual-level patient information such as gender, race, insurance type, and age, along with ZIP code-level sociomarkers such as poverty level, blight prevalence, and housing quality. Using this uniquely integrated database, we then compare the traditional biomarker-based risk model and the sociomarker-based risk model. A biomarker-based predictive model yields an accuracy of 65% and the sociomarker-based model predicts with an accuracy of 61%. Without knowing specific symptom-related features, the sociomarker-based model can correctly predict two out of three patients at risk. We systematically show that sociomarkers play an important role in predicting health outcomes at the individual level in pediatric asthma cases. Additionally, by merging multiple data sources with detailed neighborhood-level data, we directly measure the importance of residential conditions for predicting individual health outcomes.

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          Support vector machines

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            The social determinants of health: coming of age.

            In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusing on upstream social determinants-including economic resources, education, and racial discrimination-that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions. Research priorities include measuring social factors better, monitoring social factors and health relative to policies, examining health effects of social factors across lifetimes and generations, incrementally elucidating pathways through knowledge linkage, testing multidimensional interventions, and addressing political will as a key barrier to translating knowledge into action.
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              Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project.

              N Krieger (2002)
              Despite the promise of geocoding and use of area-based socioeconomic measures to overcome the paucity of socioeconomic data in US public health surveillance systems, no consensus exists as to which measures should be used or at which level of geography. The authors generated diverse single-variable and composite area-based socioeconomic measures at the census tract, block group, and zip code level for Massachusetts (1990 population: 6,016,425) and Rhode Island (1990 population: 1,003,464) to investigate their associations with mortality rates (1989-1991: 156,366 resident deaths in Massachusetts and 27,291 in Rhode Island) and incidence of primary invasive cancer (1988-1992: 140,610 resident cases in Massachusetts; 1989-1992: 19,808 resident cases in Rhode Island). Analyses of all-cause and cause-specific mortality rates and all-cause and site-specific cancer incidence rates indicated that: 1) block group and tract socioeconomic measures performed comparably within and across both states, but zip code measures for several outcomes detected no gradients or gradients contrary to those observed with tract and block group measures; 2) similar gradients were detected with categories generated by quintiles and by a priori categorical cutpoints; and 3) measures including data on economic poverty were most robust and detected gradients that were unobserved using measures of only education and wealth.
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                Author and article information

                Contributors
                eshin3@uthsc.edu
                ashabann@uthsc.edu
                Journal
                NPJ Digit Med
                NPJ Digit Med
                NPJ Digital Medicine
                Nature Publishing Group UK (London )
                2398-6352
                2 October 2018
                2 October 2018
                2018
                : 1
                : 50
                Affiliations
                [1 ]ISNI 0000 0004 0386 9246, GRID grid.267301.1, Department of Pediatrics, , University of Tennessee Health Science Center – Oak Ridge National Laboratory- (UTHSC-ORNL), Center for Biomedical Informatics, ; Memphis, TN USA
                [2 ]ISNI 0000 0004 0386 9246, GRID grid.267301.1, Department of Preventive Medicine, , UTHSC, ; Memphis, TN USA
                Author information
                http://orcid.org/0000-0003-0313-9254
                http://orcid.org/0000-0003-2047-4759
                Article
                56
                10.1038/s41746-018-0056-y
                6550159
                31304329
                eff0fcc7-3c83-46c4-92f6-167d64438a3c
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 9 March 2018
                : 6 August 2018
                : 20 August 2018
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                © The Author(s) 2018

                risk factors,population screening
                risk factors, population screening

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