TY - JOUR
T1 - Cumulative Social Disadvantage and All-Cause Mortality in the United States
T2 - Findings from a National Study
AU - Javed, Zulqarnain
AU - Valero-Elizondo, Javier
AU - Khan, Safi U.
AU - Taha, Mohamad B.
AU - Maqsood, Muhammad Haisum
AU - Mossialos, Elias
AU - Sharma, Garima
AU - Hyder, Adnan A.
AU - Cainzos-Achirica, Miguel
AU - Nasir, Khurram
N1 - Funding Information:
Dr. Nasir is on the advisory boards of Amgen and Novartis, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. The rest of the authors have no disclosures to report.
Publisher Copyright:
© 2022 Mary Ann Liebert Inc.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - The extent to which cumulative social disadvantage - defined as aggregate social risk resulting from multiple co-occurring adverse social determinants of health (SDOH) - affects the risk of all-cause mortality, independent of demographic and clinical risk factors, is not well understood. The objective of this study was to examine the association between cumulative social disadvantage, measured using a comprehensive 47-factor SDOH framework, and mortality in a nationally representative sample of adults in the United States. The authors conducted secondary analysis of pooled data for 63,540 adult participants of the 2013-2015 National Death Index-linked National Health Interview Survey. Age-adjusted mortality rates (AAMRs) were reported by quintiles of aggregate SDOH burden, with higher quintiles denoting greater social disadvantage. Cox proportional hazards models were used to examine the association between cumulative social disadvantage and risk of all-cause mortality. AAMR increased significantly with greater SDOH burden, ranging from 631 per 100,000 person-years (PYs) for participants in SDOH-Q1 to 1490 per 100,000 PYs for those in SDOH-Q5. In regression models adjusted for demographics, being in SDOH-Q5 was associated with 2.5-fold higher risk of mortality, relative to Q1 (adjusted hazard ratio [aHR] = 2.57 [95% confidence interval, CI = 1.94-3.41]); the observed association persisted after adjusting for comorbidities, with over 2-fold increased risk of mortality for SDOH-Q5 versus Q1 (aHR = 2.02 [95% CI = 1.52-2.67]). These findings indicate that cumulative social disadvantage is associated with increased risk of all-cause mortality, independent of demographic and clinical factors. Population level interventions focused on improving individuals' social, economic, and environmental conditions may help reduce the burden of mortality and mitigate persistent disparities.
AB - The extent to which cumulative social disadvantage - defined as aggregate social risk resulting from multiple co-occurring adverse social determinants of health (SDOH) - affects the risk of all-cause mortality, independent of demographic and clinical risk factors, is not well understood. The objective of this study was to examine the association between cumulative social disadvantage, measured using a comprehensive 47-factor SDOH framework, and mortality in a nationally representative sample of adults in the United States. The authors conducted secondary analysis of pooled data for 63,540 adult participants of the 2013-2015 National Death Index-linked National Health Interview Survey. Age-adjusted mortality rates (AAMRs) were reported by quintiles of aggregate SDOH burden, with higher quintiles denoting greater social disadvantage. Cox proportional hazards models were used to examine the association between cumulative social disadvantage and risk of all-cause mortality. AAMR increased significantly with greater SDOH burden, ranging from 631 per 100,000 person-years (PYs) for participants in SDOH-Q1 to 1490 per 100,000 PYs for those in SDOH-Q5. In regression models adjusted for demographics, being in SDOH-Q5 was associated with 2.5-fold higher risk of mortality, relative to Q1 (adjusted hazard ratio [aHR] = 2.57 [95% confidence interval, CI = 1.94-3.41]); the observed association persisted after adjusting for comorbidities, with over 2-fold increased risk of mortality for SDOH-Q5 versus Q1 (aHR = 2.02 [95% CI = 1.52-2.67]). These findings indicate that cumulative social disadvantage is associated with increased risk of all-cause mortality, independent of demographic and clinical factors. Population level interventions focused on improving individuals' social, economic, and environmental conditions may help reduce the burden of mortality and mitigate persistent disparities.
KW - disparities
KW - mortality
KW - social determinants of health
KW - social disadvantage
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U2 - 10.1089/pop.2022.0184
DO - 10.1089/pop.2022.0184
M3 - Article
C2 - 36473192
AN - SCOPUS:85145022391
SN - 1942-7891
VL - 25
SP - 789
EP - 797
JO - Population Health Management
JF - Population Health Management
IS - 6
ER -