Studying the Confounding Effects of Socio-Ecological Conditions in Retrospective Clinical Research: A Use Case of Social Stress

Socio-ecological Conditions (SECs) are important to include in clinical research models as they have been known to impact the health of patients. However, current clinical research models account for these factors only in an unsatisfyingly rudimentary way. In this study, we developed an SEC Index that captured the latent and direct effects of social stress, one of the many kinds of SEC, on patients’ general health as measured by the Charlson Comorbidity Index. We demonstrated that the above SEC Index had a significant effect in a clinical model, a patient-level model with the specific clinical outcome of breast cancer prevalence. Further, we demonstrated that including the SEC Index of social stress into the clinical models significantly increased their performance. Our study demonstrated a viable approach that is interchangeable to include any SEC of interest, to more appropriately account for SECs in clinical research models.