Social Determinants of Health, Cardio-Renal-Metabolic Disease, Multimorbidity, and prognosis in Community-Dwelling Adults: A prospective Chinese study.

AIMS: This study aimed to examine the associations of social determinants of health (SDOH) with transitions from health to first cardio-renal-metabolic disease (FCRMD), progression to cardio-renal-metabolic multimorbidity (CRMM), and all-cause death among community-dwelling Chinese adults.

METHODS

In this community-based prospective cohort study, 93,058 participants without FCRMD at enrollment were selected from the China PEACE Million Persons Project. SDOH comprised five components (economic stability, educational attainment, health care access, social support, and residential area) and was categorized as favorable, medium, or unfavorable. CRMM was defined as the presence of at least two of three conditions: cardiovascular disease, type 2 diabetes, and chronic kidney disease. Associations of SDOH with transitions along the CRMM progression trajectory were examined using multistate models, with transition-specific hazard ratios (HRs) and 95% confidence intervals (CIs) reported.

RESULTS

Over a median follow-up of 5.04 years, 13,471 participants developed FCRMD (incidence rate, 32.03 per 1,000 person-years), and 2,885 progressed to CRMM (incidence rate, 105.18 per 1,000 person-years). Compared with the favorable SDOH group, the unfavorable SDOH group had higher hazards of transitions from health to FCRMD (HR, 1.23; 95% CI, 1.12-1.36), from FCRMD to CRMM (HR, 1.28; 95% CI, 1.05-1.55), and from CRMM to death (HR, 2.94; 95% CI, 1.74-4.97). Among SDOH components, educational attainment and social support showed the most consistent associations throughout the progression of CRMM.

CONCLUSION

Our findings underscore the importance of integrating SDOH assessment into CRMM risk stratification and management, with targeted resource allocation toward socially disadvantaged groups.