Social Determinants

Javed, Zulqarnain; Jilani, Hashim; Yahya, Tamer; Khan, Safi U.; Hyder, Adnan A; Cainzos‐Achirica, Miguel; Kash, Bita A.; Nasir, Khurram

doi:10.1007/978-3-030-75055-8_1

Cited by 4 publications

(1 citation statement)

References 99 publications

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“…SDoH are observed to influence objective health outcomes such as morbidity and mortality [7][8][9], and patient-reported health and wellbeing [10,11]. SDoH are intricately interconnected and adverse determinants often cluster in marginalized groups [12][13][14]. Additionally, these proximal determinants can have differential impact on health which calls for a multidimensional framework in their assessment.…”

Section: Introductionmentioning

confidence: 99%

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

Hagan,

Javed,

Cainzos-Achirica

et al. 2023

BMC Public Health

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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.

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Section: Introductionmentioning

confidence: 99%

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

Hagan,

Javed,

Cainzos-Achirica

et al. 2023

BMC Public Health

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Polysocial Risk Scores: Implications for Cardiovascular Disease Risk Assessment and Management

Javed,

Kundi,

Chang

et al. 2023

Curr Atheroscler Rep

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Cumulative Social Disadvantage and Health-Related Quality of Life: National Health Interview Survey 2013-2017

Hagan

Javed

Cainzos‐Achirica

et al. 2022

Preprint

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Background: Evidence of 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: We used data of respondents from the 2013-2017 National Health Interview Survey. A cumulative SDoH index was created by aggregating 46 SDoH from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). A higher SDoH index or quartile indicates greater disadvantage. Two outcomes were assessed: HALex scores using two-part models, and a binary poor HALex (HALex score < 0.79 [20th percentile]) using logistic regression. Regression analyses adjusted for demographics and comorbidities and were performed in the overall sample, and by age, sex, and race/ethnicity categories. Results: Among 156,182 adults (mean age 46 years; 51.7% women), higher SDoH quartile groups averaged lower HALex scores and had higher proportions with poor HALex. A unit increase in SDoH index was associated with 0.01 decrease in HALex score (β = -0.01; 95% CI [-0.01, -0.01]) and 14% higher odds of poor HALex (odds ratio, OR = 1.14; 95% CI [1.14, 1.15]). Relative to SDoH-Q1, SDoH-Q4 was associated with HALex score decrease of -0.13 (95% CI [-0.13, -0.13]) and OR 8.67 (95% CI [8.08, 9.30]) for poor HALex. Hispanic persons, despite a relatively higher burden of cumulative social disadvantage, had a weaker SDoH-HALex association than their counterparts. Conclusion: Higher cumulative social disadvantage was independently associated with lower HRQoL in an incremental fashion. The more favorable HRQoL profile observed in the Hispanic could be related to a resilient concept of health derived from cultural values and acceptance, and this highlights the need for population wellness interventions to be responsive to such phenomenon.

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Social Determinants

Cited by 4 publications

References 99 publications

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

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

Polysocial Risk Scores: Implications for Cardiovascular Disease Risk Assessment and Management

Cumulative Social Disadvantage and Health-Related Quality of Life: National Health Interview Survey 2013-2017

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