Qi Xin, Liu Li, Yang Jin, Pan Chuyu, Hao Jingcan, Wei Wenming, Cheng Shiqiang, Gou Yifan, Zhao Boyue, Wen Yan, Cheng Bolun, Zhang Feng
Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China.
Key Laboratory of Trace Elements and Endemic Diseases of National Health and Family Planning Commission, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, P. R. China.
Epidemiol Psychiatr Sci. 2025 Aug 22;34:e43. doi: 10.1017/S2045796025100176.
Social determinants of health (SDHs) exert a significant influence on various health outcomes and disparities. This study aimed to explore the associations between combined SDHs and mortality, as well as adverse health outcomes among adults with depression.
The research included 48,897 participants with depression from the UK Biobank and 7,771 from the US National Health and Nutrition Examination Survey (NHANES). By calculating combined SDH scores based on 14 SDHs in the UK Biobank and 9 in the US NHANES, participants were categorized into favourable, medium and unfavourable SDH groups through tertiles. Cox regression models were used to evaluate the impact of combined SDHs on mortality (all-cause, cardiovascular disease [CVD] and cancer) in both cohorts, as well as incidences of CVD, cancer and dementia in the UK Biobank.
In the fully adjusted models, compared to the favourable SDH group, the hazard ratios for all-cause mortality were 1.81 (95% CI: 1.60-2.04) in the unfavourable SDH group in the UK Biobank cohort; 1.61 (95% CI: 1.31-1.98) in the medium SDH group and 2.19 (95% CI: 1.78-2.68) in the unfavourable SDH group in the US NHANES cohort. Moreover, higher levels of unfavourable SDHs were associated with increased mortality risk from CVD and cancer. Regarding disease incidence, they were significantly linked to higher incidences of CVD and dementia but not cancer in the UK Biobank.
Combined unfavourable SDHs were associated with elevated risks of mortality and adverse health outcomes among adults with depression, which suggested that assessing the combined impact of SDHs could serve as a key strategy in preventing and managing depression, ultimately helping to reduce the burden of disease.
健康的社会决定因素（SDH）对各种健康结果和差异有重大影响。本研究旨在探讨合并的SDH与死亡率之间的关联，以及抑郁症成年人的不良健康结果。
该研究纳入了来自英国生物银行的48897名抑郁症参与者和来自美国国家健康与营养检查调查（NHANES）的7771名参与者。通过根据英国生物银行的14项SDH和美国NHANES的9项SDH计算合并的SDH分数，参与者通过三分位数被分为有利、中等和不利的SDH组。使用Cox回归模型评估合并的SDH对两个队列中死亡率（全因、心血管疾病[CVD]和癌症）的影响，以及英国生物银行中CVD、癌症和痴呆症的发病率。
在完全调整模型中，与有利的SDH组相比，英国生物银行队列中不利的SDH组全因死亡率的风险比为1.81（95%CI：1.60-2.04）；美国NHANES队列中中等SDH组为1.61（95%CI：1.31-1.98），不利的SDH组为2.19（95%CI：1.78-2.68）。此外，更高水平的不利SDH与CVD和癌症的死亡风险增加相关。关于疾病发病率，在英国生物银行中，它们与CVD和痴呆症的更高发病率显著相关，但与癌症无关。
合并的不利SDH与抑郁症成年人的死亡风险和不良健康结果升高相关，这表明评估SDH的综合影响可以作为预防和管理抑郁症的关键策略，最终有助于减轻疾病负担。
