Jegede, Oluwole (2026) Social determinants as biomarkers of structural vulnerability in minoritized people with substance use disorders: implications for translational addiction science. Post-Doctoral thesis, University of West London.

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Abstract

Like traditional biomarkers, sociomarkers (social biomarkers) reflect disease etiology, severity, course, and prognosis. This thesis synthesizes selected peer-reviewed publications to reframe social determinants of health as clinically meaningful biomarkers of structural vulnerability, defined as an individual’s or population’s risk for adverse health outcomes arising from exposure to intersecting socioeconomic, political, and cultural hierarchies.

In the United States, minoritized communities have been disproportionately impacted by inequities in access to evidence-based treatments for substance use disorders and by an emerging racial shift in drug overdose deaths, within the context of a structurally inequitable health care system. Although existing literature identifies structural vulnerability as a final common pathway shaping health outcomes among people with substance use disorders, this construct remains poorly operationalized, and a coherent, sustainable translational framework is lacking. It is therefore critically important for public health to develop frameworks that can predict risk, inform the design of equitable interventions, and address upstream structural drivers of persistent racial and ethnic inequities.

This thesis addresses this gap by developing a translational framework that conceptualizes social determinants of health as clinically meaningful biomarkers influencing substance use disorder risk, course, and outcomes. Included studies document population-level inequities in overdose and treatment within a changing drug supply; demonstrate systemic racism-related distress as a measurable and persistent exposure associated with substance-related psychopathology; and show that social and structural factors shape remission trajectories, treatment pathways, and diagnostic complexity. Epidemiologic analyses highlight persistent disparities and within-group heterogeneity, complemented by qualitative evidence of lived structural barriers to care. Conceptual papers translate these findings into implications for harm reduction, policy, and addiction workforce development. Collectively, this body of work advances a translational framework positioning social determinants as biomarkers of structural vulnerability in addiction science.

This thesis further operationalizes interactions among social elements across multiple socioecological levels and health care system infrastructures, arguing that achieving health equity requires centering social determinants of health within culturally responsive, dynamic, and self-correcting health systems. The social determinants of health framework is expanded to include metastructural determinants, an original conceptual contribution introduced as a scaffold within a tiered system encompassing social and structural determinants. Metastructural determinants capture global, overarching forces that sustain, legitimize, and reproduce inequities while shaping structural arrangements beyond the control of any single ecological level, including colonialism, capitalism, globalization, climate change, displacement, and nativism. Reframing social determinants of health as biomarkers of structural vulnerability extends traditional biomedical models and creates new opportunities for prevention, intervention, and policy. Operationalizing social variables as weighted social indices, latent constructs, and risk vectors enables clinical risk stratification and the systematic incorporation of structural forces into predictive and causal models of substance use disorder.

Although the selection, conceptual organization, and framing of this thesis form a coherent body of scientific evidence, limitations include the inability to draw causal inferences from predominantly cross-sectional research designs and limited generalizability across diverse contexts.

Conceptualizing social determinants of health as biomarkers is therefore intended to establish a translational paradigm rather than provide definitive causal proof; further conceptual refinement, empirical validation, and implementation research will be required before this framework can be regarded as standard clinical practice. Finally, embedding socio-structural context into computational and analytic architectures in addiction research and clinical care has the potential to improve predictive validity, enhance algorithmic fairness, and increase contextual precision.

Item Type:	Thesis (Post-Doctoral)
Identifier:	10.36828/thesis/15306
Keywords:	Social determinants of health, Structural vulnerability, Substance use disorders, Health inequities, Translational addiction science
Subjects:	Social sciences > Discrimination Medicine and health > Health promotion and public health Psychology > Substance abuse/misuse
Date Deposited:	09 Sep 2026
Dates:	Date Publication status 19 January 2026 Completed
School, department or research centre:	Graduate School
Keywords:	Social determinants of health, Structural vulnerability, Substance use disorders, Health inequities, Translational addiction science
URI:	https://repository.uwl.ac.uk/id/eprint/15306

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