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

Abstract

Social determinants of health (SDOH) are associated with poor health outcomes among individuals with prevalent diseases. To quantify the association between adverse SDOH and mortality among adults without major chronic diseases in the United States (US). Prospective observational study. 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. We calculated 15-year adjusted cumulative incidences of all-cause mortality by baseline SDOH and described the trends in the prevalence of adverse SDOH. 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. 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.