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From the Exposome to the Socioexposome in COVID-19 Research—A Call for More Multidisciplinary Research

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The coronavirus disease 2019 (COVID-19) pandemic continues to expose how access to health care and delivery of care are important concerns, second only to the primary concern regarding exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the first place, and how this exposure can itself in large part be attributed to socioeconomic disparities. Originally called the Great Equalizer, it was implied that the virus itself does not discriminate. However, as the pandemic has unfolded, it has become clear that instead, SARS-CoV-2 is a magnifier of existing inequities. As Bonnie Henry, MD, MPH, the Health Minister of British Columbia, Canada, stated: “This is a storm that’s affecting the world. But we are not in the same boats.”1 Black, Indigenous, and people of color have been disproportionately affected by the COVID-19 pandemic, laying bare disparities along race and class lines.2 In their assessment of sociodemographic factors associated with use of telemedicine for ambulatory care during the COVID-19 pandemic, Eberly et al3 found that older, non–English speaking Asian patients with Medicaid insurance completed fewer telemedicine visits and that older Black and Latina women of lower socioeconomic status made less use of telemedicine with video. These findings suggest that more efficient provision of health care via higher technological tools does not guarantee more access to health care, nor better health outcomes. Furthermore, the study by Eberly et al3 highlights that more attention must be paid to socioeconomic dimensions shaping avenues of access to care. Without this attention, efforts to address parity in health care delivery could be rendered futile, akin to filling a leaky pot.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Published: December 29, 2020. doi:10.1001/jamanetworkopen.2020.32287

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Koch S et al. JAMA Network Open.

Corresponding Author: Sarah Koch, PhD, Barcelona Institute of Global Health, Barcelona Biomedical Research Park, Doctor Aiguader, 88, 08003 Barcelona, Spain (sarah.koch@isglobal.org).

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Koch acknowledges support from the Marie Sklodowska-Curie Actions Individual Fellowship Programme, Spanish Ministry of Science, Innovation and Universities through the Centro de Excelencia Severo Ochoa 2019-2023 Programme, and Generalitat de Catalunya through the Catalan Research Centres Institute Programme.

Role of the Funder/Sponsor: The funders had no role in the analysis or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

References
1.
Porter  C . The top doctor who aced the Coronavirus test. New York Times. June 5, 2020. Accessed November 3, 2020. https://www.nytimes.com/2020/06/05/world/canada/bonnie-henry-british-columbia-coronavirus.html
2.
APM Research Lab Staff. The color of coronavirus: COVID-19 deaths by race and ethnicity in the US. Updated November 12, 2020. Accessed November 3, 2020. https://www.apmresearchlab.org/covid/deaths-by-race
3.
Eberly  LA , Kallan  MJ , Julien  HM ,  et al.  Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(12):e2031640. doi:10.1001/jamanetworkopen.2020.31640Google Scholar
4.
Horton  R .  Offline: COVID-19 is not a pandemic.   Lancet. 2020;396(10255):874. doi:10.1016/S0140-6736(20)32000-6PubMedGoogle ScholarCrossref
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Rasmussen  SA , Khoury  MJ , Del Rio  C .  Precision public health as a key tool in the COVID-19 response.   JAMA. 2020;324(10):933-934. doi:10.1001/jama.2020.14992PubMedGoogle ScholarCrossref
6.
Naughton  SX , Raval  U , Harary  JM , Pasinetti  GM .  The role of the exposome in promoting resilience or susceptibility after SARS-CoV-2 infection.   J Expo Sci Environ Epidemiol. 2020;30(5):776-777. doi:10.1038/s41370-020-0232-4PubMedGoogle ScholarCrossref
7.
Senier  L , Brown  P , Shostak  S , Hanna  B .  The socio-exposome: advancing exposure science and environmental justice in a postgenomic era.   Environ Sociol. 2017;3(2):107-121. doi:10.1080/23251042.2016.1220848PubMedGoogle ScholarCrossref
8.
Shearston  JA , Johnson  AM , Domingo-Relloso  A ,  et al.  Opening a large delivery service warehouse in the South Bronx: impacts on traffic, air pollution, and noise.   Int J Environ Res Public Health. 2020;17(9):3208. doi:10.3390/ijerph17093208PubMedGoogle ScholarCrossref
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