Claudel Sophie E, Verma Ashish
Department of Medicine, Boston Medical Center, Boston, MA, USA.
Section of Nephrology, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
J Gen Intern Med. 2025 May;40(7):1527-1537. doi: 10.1007/s11606-024-09275-8. Epub 2024 Dec 11.
Social determinants of health (SDOH) are associated with poor health outcomes among individuals with prevalent diseases.
To quantify the association between adverse SDOH and mortality among adults without major chronic diseases in the United States (US).
Prospective observational study.
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.
We calculated 15-year adjusted cumulative incidences of all-cause mortality by baseline SDOH and described the trends in the prevalence of adverse SDOH.
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.
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.
健康的社会决定因素（SDOH）与患有常见疾病的个体的不良健康结果相关。
量化美国无重大慢性病的成年人中不良SDOH与死亡率之间的关联。
前瞻性观察性研究。
我们使用了来自国家健康与营养检查调查数据（1999 - 2018年）。我们纳入了11413名无高血压、糖尿病、高脂血症、严重肥胖、慢性肾病、心血管疾病、慢性呼吸道疾病、癌症、肝病、关节炎、乙型或丙型肝炎、人类免疫缺陷病毒感染或妊娠的成年人。
我们根据基线SDOH计算了全因死亡率的15年调整累积发病率，并描述了不良SDOH患病率的趋势。
平均年龄±标准差为34.9±11.2岁，64.5%为非西班牙裔白人。在中位随访10.3年期间，275名参与者死亡。对于联邦贫困水平低于100%、高中以下学历、粮食不安全以及在美国出生的参与者，全因死亡率的15年调整累积发病率分别为5.6%（95%CI，2.8 - 8.5）、5.2%（95%CI，3.2 - 7.3）、4.9%（95%CI，2.7 - 7.2）和4.0%（95%CI，2.8 - 5.2）。累积SDOH评分每增加1分，全因死亡风险增加3３% [风险比1.3３，95%CI 1.16 - 1.52]。医疗保险[风险比0.97，95%CI 0.60 - 1.55]和获得常规医疗服务来源[风险比1.23，95%CI 0.76 - 1.99]均与死亡率无关。
在这项针对美国无重大慢性病的社区居住成年人的研究中，社会风险与死亡率的关联比医疗服务可及性更强。我们的研究结果挑战了以传统医疗为中心的预防保健方法，强调需要针对SDOH采取积极的公共卫生干预措施。
