Chen Fangyuan, Nipp Ryan D, Han Xuesong, Zheng Zhiyuan, Wang Tianci, Yabroff K Robin, Jiang Changchuan
School of Medicine, Tsinghua University, Beijing, China.
OU Health Stephenson Cancer Center, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
BMC Public Health. 2025 Aug 14;25(1):2761. doi: 10.1186/s12889-025-24126-9.
Social Determinants of Health (SDOH) influences healthcare access, especially in patients with chronic diseases. However, SDOHs were often investigated as single variables. Combination patterns and joint effects of multiple SDOHs are much understudied. This study seeks to identify SDOH patterns in the US general population and their influence in all-cause and specific mortality.
This study included US adults aged 18 to 79 from 2002 to 2018 National Health Interview Survey (NHIS) and NHIS Linked Mortality Files. 12 SDOHs from 5 domains (healthcare access, education and literacy, economic stability, social isolation, neighborhood cohesion) were selected and binarized from the NHIS, including: material, psychological, and behavioral medical financial hardship, delayed care due to transportation and due to non-transportation factors, education, employment, food security, income, housing security, marital status, and neighborhood cohesion. Key outcomes, including all-cause, cancer-specific mortality, and cardiovascular disease-specific death were identified at quarter and year of death.
From the 105,824 younger adults (18–64 years), and the 23,825 older adults (65–79 years), five distinct SDOH patterns were identified: pattern 1 (31%, few barriers); 2 (20%, unmarried); 3 (17%, unemployed); 4 (15%, both unmarried and unemployed); and 5 (16%, with relatively high rate of non-married status, housing insecurity, and material, psychological, or behavioral medical financial hardships). Compared to pattern 1, pattern 4 and 5 had worse prognosis in all mortality outcomes in both age groups, including all-cause mortality, cancer-specific mortality, and cardiovascular disease-specific mortality in both age groups.
In this study, we found that SDOHs could be clustered into five distinct patterns. Patients who were unmarried and unemployed (pattern 4) or with multiple concurrent adverse SDOHs (pattern 5) had poorest key health outcomes. These findings support comprehensive screening for SDOH profiles to understand cumulative influences of SDOHs on quality of life and clinical outcomes of patients with chronic medical conditions.
The online version contains supplementary material available at 10.1186/s12889-025-24126-9.
健康的社会决定因素（SDOH）会影响医疗保健的可及性，尤其是对慢性病患者而言。然而，SDOH通常作为单一变量进行研究。多个SDOH的组合模式和联合效应的研究还很不足。本研究旨在确定美国普通人群中的SDOH模式及其对全因死亡率和特定死亡率的影响。
本研究纳入了2002年至2018年美国国家健康访谈调查（NHIS）以及NHIS关联死亡率文件中年龄在18至79岁的美国成年人。从NHIS中选取了5个领域（医疗保健可及性、教育与读写能力、经济稳定性、社会孤立、社区凝聚力）的12个SDOH，并将其进行二分类，包括：物质、心理和行为方面的医疗财务困难、因交通和非交通因素导致的延迟就医、教育程度、就业情况、食品安全、收入、住房保障、婚姻状况以及社区凝聚力。在死亡季度和年份确定主要结局，包括全因死亡率、特定癌症死亡率和特定心血管疾病死亡率。
在105,824名年轻成年人（18 - 64岁）和23,825名年长成年人（65 - 79岁）中，确定了五种不同的SDOH模式：模式1（31%，障碍较少）；模式2（20%，未婚）；模式3（17%，失业）；模式4（15%，未婚且失业）；模式5（16%，非婚状况、住房不安全以及物质、心理或行为方面的医疗财务困难发生率相对较高）。与模式1相比，模式4和模式5在两个年龄组的所有死亡率结局中预后更差，包括两个年龄组的全因死亡率、特定癌症死亡率和特定心血管疾病死亡率。
在本研究中，我们发现SDOH可聚类为五种不同模式。未婚且失业的患者（模式4）或同时存在多种不良SDOH的患者（模式5）的关键健康结局最差。这些发现支持对SDOH概况进行全面筛查，以了解SDOH对慢性病患者生活质量和临床结局的累积影响。
在线版本包含可在10.1186/s12889-025-24126-9获取的补充材料。
