TY - JOUR
T1 - Cumulative social disadvantage and health-related quality of life
T2 - national health interview survey 2013–2017
AU - Hagan, Kobina
AU - Javed, Zulqarnain
AU - Cainzos-Achirica, Miguel
AU - Hyder, Adnan A.
AU - Mossialos, Elias
AU - Yahya, Tamer
AU - Acquah, Isaac
AU - Valero-Elizondo, Javier
AU - Pan, Alan
AU - Nwana, Nwabunie
AU - Taha, Mohamad
AU - Nasir, Khurram
N1 - Funding Information:
KN is on the advisory board of Amgen and Novartis, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. KN and MCA are on the Steering Committee of the PAK-SEHAT Study, partially funded by an unrestricted research grant from Getz Pharma. AAH declares current funding from the United States National Institutes of Health, the World Bank, and the World Health Organization. The other authors report no conflicts of interest relevant to this work.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/9/4
Y1 - 2023/9/4
N2 - Background: Evidence for the association between social determinants of health (SDoH) and health-related quality of life (HRQoL) is largely based on single SDoH measures, with limited evaluation of cumulative social disadvantage. We examined the association between cumulative social disadvantage and the Health and Activity Limitation Index (HALex). Methods: Using adult data from the National Health Interview Survey (2013–2017), we created a cumulative disadvantage index by aggregating 47 deprivations across 6 SDoH domains. Respondents were ranked using cumulative SDoH index quartiles (SDoH-Q1 to Q4), with higher quartile groups being more disadvantaged. We used two-part models for continuous HALex scores and logistic regression for poor HALex (< 20th percentile score) to examine HALex differences associated with cumulative disadvantage. Lower HALex scores implied poorer HRQoL performance. Results: The study sample included 156,182 respondents, representing 232.8 million adults in the United States (mean age 46 years; 51.7% women). The mean HALex score was 0.85 and 17.7% had poor HALex. Higher SDoH quartile groups had poorer HALex performance (lower scores and increased prevalence of poor HALex). A unit increase in SDoH index was associated with − 0.010 (95% CI [-0.011, -0.010]) difference in HALex score and 20% higher odds of poor HALex (odds ratio, OR = 1.20; 95% CI [1.19, 1.21]). Relative to SDoH-Q1, SDoH-Q4 was associated with HALex score difference of -0.086 (95% CI [-0.089, -0.083]) and OR = 5.32 (95% CI [4.97, 5.70]) for poor HALex. Despite a higher burden of cumulative social disadvantage, Hispanics had a weaker SDoH-HALex association than their non-Hispanic White counterparts. Conclusions: Cumulative social disadvantage was associated with poorer HALex performance in an incremental fashion. Innovations to incorporate SDoH-screening tools into clinical decision systems must continue in order to accurately identify socially vulnerable groups in need of both clinical risk mitigation and social support. To maximize health returns, policies can be tailored through community partnerships to address systemic barriers that exist within distinct sociodemographic groups, as well as demographic differences in health perception and healthcare experience.
AB - Background: Evidence for the association between social determinants of health (SDoH) and health-related quality of life (HRQoL) is largely based on single SDoH measures, with limited evaluation of cumulative social disadvantage. We examined the association between cumulative social disadvantage and the Health and Activity Limitation Index (HALex). Methods: Using adult data from the National Health Interview Survey (2013–2017), we created a cumulative disadvantage index by aggregating 47 deprivations across 6 SDoH domains. Respondents were ranked using cumulative SDoH index quartiles (SDoH-Q1 to Q4), with higher quartile groups being more disadvantaged. We used two-part models for continuous HALex scores and logistic regression for poor HALex (< 20th percentile score) to examine HALex differences associated with cumulative disadvantage. Lower HALex scores implied poorer HRQoL performance. Results: The study sample included 156,182 respondents, representing 232.8 million adults in the United States (mean age 46 years; 51.7% women). The mean HALex score was 0.85 and 17.7% had poor HALex. Higher SDoH quartile groups had poorer HALex performance (lower scores and increased prevalence of poor HALex). A unit increase in SDoH index was associated with − 0.010 (95% CI [-0.011, -0.010]) difference in HALex score and 20% higher odds of poor HALex (odds ratio, OR = 1.20; 95% CI [1.19, 1.21]). Relative to SDoH-Q1, SDoH-Q4 was associated with HALex score difference of -0.086 (95% CI [-0.089, -0.083]) and OR = 5.32 (95% CI [4.97, 5.70]) for poor HALex. Despite a higher burden of cumulative social disadvantage, Hispanics had a weaker SDoH-HALex association than their non-Hispanic White counterparts. Conclusions: Cumulative social disadvantage was associated with poorer HALex performance in an incremental fashion. Innovations to incorporate SDoH-screening tools into clinical decision systems must continue in order to accurately identify socially vulnerable groups in need of both clinical risk mitigation and social support. To maximize health returns, policies can be tailored through community partnerships to address systemic barriers that exist within distinct sociodemographic groups, as well as demographic differences in health perception and healthcare experience.
KW - HALex
KW - Health and Activity Limitation Index
KW - Health-related quality of life
KW - Quality of life
KW - Social determinants of health
KW - Humans
KW - Middle Aged
KW - Male
KW - Hispanic or Latino
KW - Social Determinants of Health
KW - Socioeconomic Disparities in Health
KW - Quality of Life
KW - Adult
KW - Female
KW - Surveys and Questionnaires
KW - Odds Ratio
UR - http://www.scopus.com/inward/record.url?scp=85169698036&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85169698036&partnerID=8YFLogxK
U2 - 10.1186/s12889-023-16168-8
DO - 10.1186/s12889-023-16168-8
M3 - Article
C2 - 37667245
AN - SCOPUS:85169698036
SN - 1471-2458
VL - 23
JO - BMC Public Health
JF - BMC Public Health
IS - 1
M1 - 1710
ER -