High Social Risk and Biomarkers of Systemic Inflammation

Dear Editor,

We are grateful for the comments shared in the Letter to the Editor regarding our article, “High Social Risk and Biomarkers of Systemic Inflammation: a population-based study in middle-aged and older adults living in rural communities.” ¹ The authors’ initiative to contextualize our findings within the Philippine Geographically Isolated and Disadvantaged Areas (GIDAs) reinforces the importance of transnational dialogue in advancing rural health equity.

We commend the authors’ recognition that the Gijon’s Social-Familial Evaluation Scale (SFES) and inflammatory biomarkers such as the Systemic immune inflammation index and the C-reactive protein/albumin ratio offer valuable tools for social risk stratification. As underscored in their letter, social vulnerabilities faced by rural Ecuadorian communities parallel those in the Philippines, making such tools potentially impactful across different regions. The opportunity to further compare results is welcomed.

In that spirit, we respectfully suggest that while the Gijon’ SFES offers a robust multidimensional construct, its adaptation to reflect specific cultural and environmental realities of Filipino populations could enhance its utility. Tailoring the assessment of Social Determinants of Health to local context, for instance, incorporating regional patterns of internal migration, health-seeking behaviors, and indigenous community dynamics, could yield more context-sensitive data to inform equitable intervention strategies.

We also resonate strongly with the authors’ call for ethical implementation. Biomarker-informed strategies should serve to elevate, not marginalize, underserved populations. Embedding these tools in a health system that values social justice can turn data into action and guide the allocation of much-needed resources in these populations.

Finally, we thank the authors for their thoughtful contribution and look forward to continued exchange around tools and practices that advance health equity in low-resource settings.

Oscar H. Del BruttoUniversidad Espíritu Santo – Ecuador, Samborondón, Ecuador Robertino M. Mera,Freenome, Inc., South San Francisco, CA, USA