Cumulative adverse social determinants of health, prolonged unsuccessful conception, and infertility-related healthcare contact among U.S. women: NHANES 2013-2016.

PURPOSE: To examine whether cumulative adverse social determinants of health (SDOH) were associated differently with self-reported prolonged unsuccessful conception, infertility-related healthcare contact, and healthcare contact among women reporting prolonged unsuccessful conception.

METHODS

We analyzed women aged 20-59 years from the 2013-2016 National Health and Nutrition Examination Survey (NHANES). The final Model 2 cohort included 3145 participants. An eight-domain adverse SDOH score was calculated only when every domain was determinable. Survey-weighted logistic regression estimated associations per 1-point higher score. Model 1 adjusted for flexible age and race/ethnicity; Model 2 additionally adjusted for smoking, alcohol use, and BMI category; Model 3 additionally adjusted for cardiovascular disease, hypertension, diabetes, and hyperlipidemia. Sensitivity analyses evaluated reproductive eligibility, exposure construction, survey cycle, and selection.

RESULTS

In Model 2, each 1-point higher SDOH score was associated with lower odds of reporting at least 12 months of unsuccessful conception (OR 0.91, 95% CI 0.85-0.98), infertility-related healthcare contact (OR 0.86, 95% CI 0.80-0.92), and healthcare contact among women reporting prolonged unsuccessful conception (OR 0.81, 95% CI 0.69-0.94). The unsuccessful conception estimate attenuated toward the null under several stricter reproductive eligibility restrictions and after omission of the marital/social domain. The healthcare contact associations were more directionally consistent. Pregnancy history interactions did not provide clear evidence of heterogeneity, and age heterogeneity was specification-sensitive.

CONCLUSION

Greater cumulative social disadvantage was associated with lower odds of reporting a ≥ 12-month unsuccessful conception history and, more consistently, lower odds of infertility-related healthcare contact. These cross-sectional patterns may reflect reproductive opportunity, partnership and social context, recognition/reporting, and access to care; they should not be interpreted as evidence that social disadvantage improves biological fecundability.