Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017

Abstract

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.

Unfavorable social determinants of health and risk of mortality in adults with diabetes: findings from the National Health Interview Survey

“… 25 26 A comprehensive SDOH index, as used in this study, may inform future development of holistic social risk assessment approaches and evidence-based, individualized social support interventions. 27 In contrast to prior reports, ours is the first nationally representative study to comprehensively describe the burden of social disadvantage experienced by adults with diabetes and the extent to which it predicts mortality in this population. We found that, at each SDOH quartile, people with diabetes faced 1.5-fold to 2-fold higher AAMR than people without diabetes.…”

“…Furthermore, prior work assessing aggregate SDOH burden and clinical outcomes is primarily based on a relatively small number of SDOH, is focused on the general population or defined clinical subgroups other than diabetes, or assesses non-mortality outcomes 25 26. A comprehensive SDOH index, as used in this study, may inform future development of holistic social risk assessment approaches and evidence-based, individualized social support interventions 27. In contrast to prior reports, ours is the first nationally representative study to comprehensively describe the burden of social disadvantage experienced by adults with diabetes and the extent to which it predicts mortality in this population.…”

The Toxic Stress of Racism and Its Relationship to Frailty

“…The World Health Organization (2023) defines SDOH as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH potentiate disproportionate disease burden among historically marginalized communities (Hagan et al, 2023). For example, several measures of social vulnerability and SDOH illustrate the challenges faced by Hispanic/Latino communities in San Diego County.…”