A scoping review of definitions and conceptualizations of ecosyndemics in syndemic research

Background Ecosyndemic research focuses on the role of environmental contextual factors in syndemics. However, there is no consensus on the difference between syndemics and ecosyndemics, as the physical environment is often also included in syndemic studies. This review aims to describe the definitions used, environmental aspects included, and methods employed in ecosyndemic and syndemic studies with an environmental contextual focus.

We conducted a literature search across five databases. We screened articles in two phases: software-assisted screening and manual full-text screening. To distinguish common elements, ecosyndemic and syndemics definitions were coded. Information regarding methods, factors related to the physical environment, and study results were extracted from the empirical articles.

A total of 169 publications were included, 16 used an ecosyndemic definition, 137 a syndemic one, and 16 a global syndemic definition. Most articles were nonempirical (n=112). Two types of ecosyndemic conceptualizations were distinguished: the extension conceptualization (n=10), which emphasizes the role of the physical environmental context in combination with other contextual factors, and the trigger conceptualization (n=6), which focuses on how environmental factors can trigger a syndemic. The built environment was studied most frequently (n=48), the food environment the least (n=18).

The ecosyndemic framework highlights the role of the physical and social environment in worsened population-level health outcomes, which could inform health policies. Ecosyndemic research should focus on a multidisciplinary understanding of it through knowledge triangulation derived from different scientific disciplines to ensure that all aspects of ecosyndemics—clustering, interaction, and social and environmental contextual drivers—are included. Competing Interest Statement The authors have declared no competing interest. Funding Statement This project received funding from the Netherlands Organization for Health Research and Development (ZoNMW), grant no: 05550032110023 and the “ECOTIP” project (with project number NWA.1518.22.151) of the research program “Dutch Research Agenda Routes by Consortia” (NWA-ORC 2022) which is financed by the Dutch Research Council (NWO). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present work are contained in the manuscript.