Cumulative adverse social determinants of health and the odds of self-reported rheumatoid arthritis: a national study.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disease influenced by not only biological but also social and environmental factors. However, the cumulative associations of multiple social determinants of health (SDoHs) with prevalent RA remain underexplored.

METHODS: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018, including 32,758 adults aged ≥ 20 years after exclusions. Rheumatoid arthritis (RA) cases (n = 1,832) were identified based on participants' self-reported physician diagnosis using the NHANES arthritis questionnaire. Survey-weighted logistic regression models were applied to examine associations between cumulative social determinants of health (SDoHs) and prevalent RA. Eight SDoH indicators were evaluated: employment status, family income-to-poverty ratio, food security, educational attainment, health insurance coverage, type of health insurance, home ownership, and marital status. Each variable was dichotomized as favorable or unfavorable. A cumulative SDoH score was calculated by summing the number of unfavorable conditions. Survey-weighted logistic regression models were used to assess associations between SDoHs and RA, with stratified analyses by sex and race or ethnicity.

RESULTS: Five SDoHs including unemployment, low income-to-poverty ratio, food insecurity, low educational attainment, and non-private health insurance were independently associated with higher odds of prevalent self-reported RA. A significant graded association was observed between the number of unfavorable SDoHs and the odds of prevalent rheumatoid arthritis. Participants with five unfavorable conditions had 4.69 times higher odds of prevalent RA compared with those with none (95 percent confidence interval 3.42 to 6.44, P for trend < 0.0001). The association was stronger among women and in the White subgroup.

CONCLUSION: Cumulative exposure to adverse social determinants was cross-sectionally associated with higher odds of self-reported RA. These findings may help inform equity-oriented care and future research; longitudinal studies are needed to clarify temporality and causality. Key Points • Cumulative Association of Social Determinants: The study demonstrates that cumulative exposure to multiple adverse social determinants of health, including unemployment, low income, food insecurity, low education, and non-private health insurance, is significantly associated with higher odds of prevalent self-reported rheumatoid arthritis. • Graded Association: A graded association was observed between the number of unfavorable social determinants and the odds of prevalent rheumatoid arthritis, with a higher number of unfavorable conditions correlating with higher odds of disease. • Sex and Racial/Ethnic Variations: The study found that the associations between social determinants and the odds of prevalent rheumatoid arthritis varied across sex and racial/ethnic groups, with stronger associations observed in women and White individuals. • Public Health Implications: Inequalities in social factors such as employment, income, education, food security, and healthcare access may help contextualize disparities in rheumatoid arthritis burden and support equity-oriented interpretation.