Infectious disease models and social determinants of health: A systematic review of modelling guidelines

17 March 2021

COVID-19 has disproportionately affected marginalized racial, ethnic and socioeconomic groups, both through its unequal health burden and its disparity of economic losses. Infectious disease models have formed the backbone of policy decisions at all levels. Despite empirical evidence on significant inequalities in the impact of the pandemic, current epidemiological models are mostly based on an average population approach and ignore social factors in predicting the course of pandemic and in analyses of policy options. This is partly because there is limited guidance on how infectious disease models should incorporate social determinants of health. We systematically reviewed international guidelines for developing and reporting infectious disease models and identified best practices and recommendations for incorporating social determinants of health into models to inform policy decisions. After reviewing 631 unique citations, we identified 19 guidelines on infectious disease models. 14 of 19 made direct and specific reference to at least one social factor. Age was the most commonly recommended social factor (11 guidelines), followed by sex and gender (5), socioeconomic status (5), race and ethnicity (3), immigration and migration patterns (3) and geography/climate (3). The reasons provided for considering social factors were a) defining and contextualizing the decision problem, b) improving model choice, accuracy and precision, c) characterizing disease process and dynamics, d) understanding geographic patterns and heterogeneity in population groups, and e) addressing inequalities. We discuss specific recommendations and challenges identified in these guidelines to help COVID-19 modellers in appropriately considering and accounting social factors.

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Dr. Shehzad Ali, Associate Professor, Western University, Dr. Ava A. John-Baptiste, Associate Professor, Western University