Social Determinants of Health and Cumulative Incidence of Mortality Among US Adults Without Major Chronic Diseases

Sophie E Claudel; Ashish Verma

doi:10.1007/s11606-024-09275-8

Social Determinants of Health and Cumulative Incidence of Mortality Among US Adults Without Major Chronic Diseases

J Gen Intern Med. 2024 Dec 11. doi: 10.1007/s11606-024-09275-8. Online ahead of print.

Authors

Sophie E Claudel¹, Ashish Verma^{2

3

4}

Affiliations

¹ Department of Medicine, Boston Medical Center, Boston, MA, USA.
² Department of Medicine, Boston Medical Center, Boston, MA, USA. Ashish.Verma@bmc.org.
³ Section of Nephrology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA. Ashish.Verma@bmc.org.
⁴ Chobanian & Avedisian School of Medicine, Boston University, Evans Biomedical Research Center, 650 Albany Street, Boston, MA02118, X-509, USA. Ashish.Verma@bmc.org.

PMID: 39663346
DOI: 10.1007/s11606-024-09275-8

Abstract

Background: Social determinants of health (SDOH) are associated with poor health outcomes among individuals with prevalent diseases.

Objective: To quantify the association between adverse SDOH and mortality among adults without major chronic diseases in the United States (US).

Design: Prospective observational study.

Participants: We used data from the National Health and Nutrition Examination Survey data (1999-2018). We included 11,413 adults without hypertension, diabetes, hyperlipidemia, severe obesity, chronic kidney disease, cardiovascular disease, chronic respiratory disease, cancer, liver disease, arthritis, hepatitis B or C, human immunodeficiency virus, or pregnancy.

Main measures: We calculated 15-year adjusted cumulative incidences of all-cause mortality by baseline SDOH and described the trends in the prevalence of adverse SDOH.

Key results: The mean ±SD age was 34.9±11.2 years and 64.5% were non-Hispanic White. Over a median follow-up of 10.3 years, 275 participants died. The 15-year adjusted cumulative incidences of all-cause mortality were 5.6% (95%CI, 2.8-8.5), 5.2% (95%CI, 3.2-7.3), 4.9% (95%CI, 2.7-7.2), and 4.0% (95%CI, 2.8-5.2) for participants who had < 100% of the federal poverty level, were below high school education, had food insecurity, and were born in the US, respectively. A 1-point increase in cumulative SDOH score was associated with 33% increased risk of all-cause mortality [HR 1.33, 95%CI 1.16-1.52]. Neither health insurance [HR 0.97, 95%CI 0.60-1.55] nor access to a usual source of care [HR 1.23, 95%CI 0.76-1.99] was associated with mortality.

Conclusions: In this study of community-dwelling US adults without major chronic diseases, social risks were more strongly associated with mortality than healthcare access. Our findings challenge the conventional healthcare-centric approach to preventative care, emphasizing the need for proactive public health interventions targeting SDOH.

Keywords: NHANES; cumulative incidence; education; food security; income; mortality; social determinants of health.