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Sick Individuals and Sick (Microbial) Populations: Challenges in Epidemiology and the Microbiome

Research output: Contribution to journalReview articlepeer-review

Jennifer Beam Dowd, Audrey Renson, Pamela Herd

Original languageEnglish
JournalAnnual Review of Public Health
Accepted/In press3 Sep 2019

King's Authors


The human microbiome represents a new frontier in understanding the
biology of human health. While epidemiology in this area is still in its
infancy, its scope will likely expand dramatically over the coming years. To
rise to the challenge, we argue that epidemiology should capitalize on its
population perspective as a critical complement to molecular microbiome
research, allowing for the illumination of contextual mechanisms that
may vary more across populations rather than among individuals. We first
briefly review current research on social context and the gut microbiome,
focusing specifically on socioeconomic status (SES) and race/ethnicity.
Next, we reflect on the current state of microbiome epidemiology through
the lens of one specific area, the association of the gut microbiome and
metabolic disorders. We identify key methodological shortcomings of
current epidemiological research in this area, including extensive selection
bias, the use of noncompositionally robust measures, and a lack of attention
to social factors as confounders or effect modifiers.

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