What is a Syndemic?

2023-08-30 Mark Gualtieri Wellness

Syndemic theory
Sepsis
SAVA (substance abuse, violence, and AIDS)
OATH (Opioids and other substances, Aging, Alcohol, Tobacco, and HIV)
COVID-19: A syndemic?
Need for Syndemic model
References
Further reading

A syndemic is defined by two or more illness states interacting poorly with each other and negatively influencing the mutual course of each disease trajectory.

Syndemics is a conceptual framework for explaining diseases or health disorders that emerge in communities and are aggravated by the social, economic, environmental, and political milieu in which they exist.

It refers to the importance of biological, social, economic, and environmental elements in individual and population health.

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Syndemic theory

Syndemic theory, which has its roots in medical anthropology, has proven innovative in addressing other significant public health concerns apart from its application to chronic diseases.

This could be owing to its origins in describing HIV inequality trends at the community level. Syndemic frameworks have played an essential role in defining public health responses to major public health concerns, such as the VIDDA (violence, immigration, depression, type 2 diabetes, and abuse) syndemic among Mexican immigrant women in the United States.

The syndemic theory frame has three tenets. First, two or more diseases cluster inside a community. Second, disease interactions can be measured by bio-bio, bio-social, or bio-psychological channels. Third, large-scale influences, from the macro to the meso- to the micro-level, precipitate this disease concentration.

Sepsis

Sepsis is a major global health issue, with almost 50 million cases reported annually. Although sepsis is a problem in nearly every country, certain groups are significantly more vulnerable than others.

In the United States, sepsis risk is mostly driven by age, multimorbidity, or the coexistence of two or more chronic illnesses. Sepsis, multimorbidity, aging, poor healthcare access, and quality coexist within a network of complicated social and biological interactions, indicating a syndemic.

SAVA (substance abuse, violence, and AIDS)

Singer and colleagues developed the 'SAVA Syndemic' to describe how substance abuse, violence, and AIDS interact. SAVA highlighted why, at the population level, AIDS disproportionately afflicted those living in the inner cities of the United States, as well as how substance addiction and violence were intimately tied to AIDS in this setting.

This is predicated on the idea that AIDS is caused by mutually reinforcing elements of a syndemic health crisis marked by poverty, high unemployment, and institutional violence. These factors, when combined, encourage risky behaviors such as substance abuse and interpersonal violence. As a result, it focused on a critical triad of substance abuse, violence, and AIDS, which manifested at the individual level but was unveiled at the population level.

OATH (Opioids and other substances, Aging, Alcohol, Tobacco, and HIV)

People living with HIV (PLWH) are getting older, continuing to use alcohol and other drugs, and experiencing age-related side effects. Substance abuse, HIV, and aging are all connected in a new syndemic (OATH), contributing to age-related consequences like frailty and falls.

These elements interact biologically via shared mechanisms such as inflammation and immunological dysregulation. They are also linked to multimorbidity and polypharmacy.

Over 70% of PLWH in the United States will be 50 or older by 2020. Alcohol and substance abuse are significantly more prevalent among HIV-infected seniors. Frailty and falls are significant issues affecting the health of PLWH, who continue to use alcohol and other substances.

Frailty is an age-related condition linked to poverty in the PLWH. Chronic non-AIDS comorbidities rise with age but are more common in women and non-Hispanic Blacks.

Racism, poverty, sex bias, stress, and stigma are all social circumstances that contribute to the existence and maintenance of this syndemic.

COVID-19: A syndemic?

Globally, the connections between COVID-19, chronic comorbidities, and societal situations have suggested that some factors be considered part of a syndemic.

Diabetes and COVID-19 are related to considerable morbidity and mortality in the United States. Similarly, in low-income nations, musculoskeletal problems pose a substantial risk of COVID-19-related death.

Diabetes, obesity, and cardiovascular disease are all linked to an increased risk of severe COVID-19 and death.

It has been shown that SARS-CoV-2 can induce several pro-inflammatory cytokines, and patients with severe COVID-19 develop cytokine storm syndrome. These inflammatory cytokines play a significant role in diabetes and cardiovascular disease.

Other researchers have discovered that COVID-19 is linked to myocardial damage, such as myocarditis and arrhythmia, which are linked to an increased risk of death. In adults and children, plasma cardiac biomarkers such as high-sensitivity troponin and creatine kinase are also linked to COVID-19 severity.

Poor nutrition, psychiatric conditions, depression, suicide, domestic violence, and a lack of access to health services have all contributed to the COVID-19 pandemic becoming a syndemic. Increased unemployment, economic collapse, and widespread poverty have aggravated the situation in several geographical areas.

Furthermore, the virus's transmission, as well as its complications and fatalities, has been aided among persons with the lowest socioeconomic status and those living in crowded places.

Socioeconomic inequalities are becoming increasingly important during ongoing vaccination programs, as they contribute to discrepancies in care across ethnic groups and geographical areas.

What is a Syndemic?

Need for syndemic model

Syndemic thinking necessitates a shift in therapeutic practice to consider how social distress might impair clinical interventions for co-occurring diseases, particularly when it becomes chronic.

The co-occurrence of psychosocial and structural difficulties and the increased disease burden experienced by vulnerable populations (e.g., homeless and marginally housed women) necessitates immediate treatment.

Community support groups, social and cultural resources, home visits, and mental healthcare are all important components of syndemic therapies. Future syndemic thinking efforts should examine and incorporate these numerous levels of impact into clinical care to improve people's health and wellness throughout their lives.

References

Rudd, K. E., Mair, C. F., & Angus, D. C. (2022). Applying Syndemic Theory to Acute Illness. JAMA, 327(1), 33–34. https://doi.org/10.1001/jama.2021.22583
Mendenhall, E., Kohrt, B. A., Logie, C. H., & Tsai, A. C. (2022). Syndemics and clinical science. Nature medicine, 28(7), 1359–1362. https://doi.org/10.1038/s41591-022-01888-y
Al Mahmeed, W., Al-Rasadi, K., Banerjee, Y., Ceriello, A., Cosentino, F., Galia, M., Goh, S. Y., Kempler, P., Lessan, N., Papanas, N., Rizvi, A. A., Santos, R. D., Stoian, A. P., Toth, P. P., Rizzo, M., & CArdiometabolic Panel of International experts on Syndemic COvid-19 (CAPISCO) (2021). Promoting a Syndemic Approach for Cardiometabolic Disease Management During COVID-19: The CAPISCO International Expert Panel. Frontiers in cardiovascular medicine, 8, 787761. https://doi.org/10.3389/fcvm.2021.787761
Courtin, E., & Vineis, P. (2021). COVID-19 as a Syndemic. Frontiers in public health, 9, 763830. https://doi.org/10.3389/fpubh.2021.763830
Yadav, U. N., Rayamajhee, B., Mistry, S. K., Parsekar, S. S., & Mishra, S. K. (2020). A Syndemic Perspective on the Management of Non-communicable Diseases Amid the COVID-19 Pandemic in Low- and Middle-Income Countries. Frontiers in public health, 8, 508. https://doi.org/10.3389/fpubh.2020.00508
Womack, J. A., & Justice, A. C. (2020). The OATH Syndemic: opioids and other substances, aging, alcohol, tobacco, and HIV. Current opinion in HIV and AIDS, 15(4), 218–225. https://doi.org/10.1097/COH.0000000000000635
Mendenhall, E., & Singer, M. (2020). What constitutes a syndemic? Methods, contexts, and framing from 2019. Current opinion in HIV and AIDS, 15(4), 213–217. https://doi.org/10.1097/COH.0000000000000628
The Lancet (2017). Syndemics: health in context. Lancet (London, England), 389(10072), 881. https://doi.org/10.1016/S0140-6736(17)30640-2
Singer, M. (1996). A dose of drugs, a touch of violence and case of AIDS: conceptualizing the SAVA syndemic. Free Inq. Creat. Sociol., 24, 99–110.