Journal of general internal medicine · 2024
Social Determinants of Health and Cumulative Incidence of Mortality Among US Adults Without Major Chronic Diseases.
СтатьяНаблюдательное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Claudel Sophie E, Verma Ashish
Аннотация
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.
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.