Independent associations of social determinants of health with mortality and added predictive value beyond life's essential 8.

IF 2.8 3区 医学 Q3 ENVIRONMENTAL SCIENCES
Yuansong Zhuang, Xinlong Zhao, Siqi Tang, Yakun Zhao, Yanbo Liu, Yuxiong Chen, Yitao Han, Jinyan Lei, Zhongjie Fan
{"title":"Independent associations of social determinants of health with mortality and added predictive value beyond life's essential 8.","authors":"Yuansong Zhuang, Xinlong Zhao, Siqi Tang, Yakun Zhao, Yanbo Liu, Yuxiong Chen, Yitao Han, Jinyan Lei, Zhongjie Fan","doi":"10.1186/s41043-025-01038-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Social Determinants of Health (SDoHs) exert their influence primarily through social structures and environmental conditions. However, limited evidence exists regarding which specific SDoHs are associated with all-cause and cardiovascular mortality, and whether incorporating SDoHs into the Life's Essential 8 (LE8) framework improves mortality prediction.</p><p><strong>Methods: </strong>Data were analyzed from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Weighted Cox proportional hazards models were used to estimate associations between SDoHs and mortality. Additive interaction effects were quantified using the relative excess risk due to interaction (RERI). Predictive performance was assessed using continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) for all-cause and cardiovascular mortality.</p><p><strong>Results: </strong>Among 22,938 participants, 2,344 all-cause deaths (7.29%) and 720 cardiovascular deaths (2.12%) were observed over a median follow-up of 7.83 years. Multivariable analyses revealed that unemployment (HR = 1.44, 95% CI: 1.25-1.66), low-income status (poverty-to-income ratio (PIR) < 1; HR = 1.75, 95% CI: 1.32-2.31), severe food insecurity (HR = 1.45, 95% CI: 1.19-1.78), and being unmarried or living alone (HR = 1.43, 95% CI: 1.28-1.59) were independent predictors of all-cause mortality (all P < 0.001). Low PIR (HR = 1.90, 95% CI: 1.21-2.97) and being unmarried or living alone (HR = 1.52, 95% CI: 1.26-1.85) were also significantly associated with cardiovascular mortality. Significant additive interactions were found between unemployment and low PIR (RERI = 0.90), food insecurity (RERI = 0.59), and unmarried or living alone (RERI = 0.37) for all-cause mortality. An additive interaction between low PIR and unmarried or living alone (RERI = 0.46) was observed for cardiovascular mortality. Including these SDoHs significantly improved 1-, 3-, 5-, and 10-year prediction of all-cause and cardiovascular mortality (NRI and IDI, all P < 0.05).</p><p><strong>Conclusion: </strong>Unemployment, low PIR, severe food insecurity, and being unmarried or living alone were identified as independent predictors of increased all-cause mortality. Low PIR and being unmarried or living alone were also associated with cardiovascular mortality. Incorporating these SDoHs into the LE8 framework improved predictive performance for both mortality outcomes.</p>","PeriodicalId":15969,"journal":{"name":"Journal of Health, Population, and Nutrition","volume":"44 1","pages":"286"},"PeriodicalIF":2.8000,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341271/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health, Population, and Nutrition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s41043-025-01038-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENVIRONMENTAL SCIENCES","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Social Determinants of Health (SDoHs) exert their influence primarily through social structures and environmental conditions. However, limited evidence exists regarding which specific SDoHs are associated with all-cause and cardiovascular mortality, and whether incorporating SDoHs into the Life's Essential 8 (LE8) framework improves mortality prediction.

Methods: Data were analyzed from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Weighted Cox proportional hazards models were used to estimate associations between SDoHs and mortality. Additive interaction effects were quantified using the relative excess risk due to interaction (RERI). Predictive performance was assessed using continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) for all-cause and cardiovascular mortality.

Results: Among 22,938 participants, 2,344 all-cause deaths (7.29%) and 720 cardiovascular deaths (2.12%) were observed over a median follow-up of 7.83 years. Multivariable analyses revealed that unemployment (HR = 1.44, 95% CI: 1.25-1.66), low-income status (poverty-to-income ratio (PIR) < 1; HR = 1.75, 95% CI: 1.32-2.31), severe food insecurity (HR = 1.45, 95% CI: 1.19-1.78), and being unmarried or living alone (HR = 1.43, 95% CI: 1.28-1.59) were independent predictors of all-cause mortality (all P < 0.001). Low PIR (HR = 1.90, 95% CI: 1.21-2.97) and being unmarried or living alone (HR = 1.52, 95% CI: 1.26-1.85) were also significantly associated with cardiovascular mortality. Significant additive interactions were found between unemployment and low PIR (RERI = 0.90), food insecurity (RERI = 0.59), and unmarried or living alone (RERI = 0.37) for all-cause mortality. An additive interaction between low PIR and unmarried or living alone (RERI = 0.46) was observed for cardiovascular mortality. Including these SDoHs significantly improved 1-, 3-, 5-, and 10-year prediction of all-cause and cardiovascular mortality (NRI and IDI, all P < 0.05).

Conclusion: Unemployment, low PIR, severe food insecurity, and being unmarried or living alone were identified as independent predictors of increased all-cause mortality. Low PIR and being unmarried or living alone were also associated with cardiovascular mortality. Incorporating these SDoHs into the LE8 framework improved predictive performance for both mortality outcomes.

健康的社会决定因素与死亡率的独立关联,以及超出生命基本要素的附加预测价值。
背景:健康的社会决定因素主要通过社会结构和环境条件发挥影响。然而,关于哪些特定的SDoHs与全因死亡率和心血管死亡率相关,以及将SDoHs纳入生命基本8 (LE8)框架是否能改善死亡率预测,证据有限。方法:分析2005-2018年国家健康与营养检查调查(NHANES)的数据。加权Cox比例风险模型用于估计SDoHs与死亡率之间的关联。使用相互作用的相对超额风险(rei)对加性相互作用效应进行量化。使用全因死亡率和心血管死亡率的持续净再分类改善(NRI)和综合判别改善(IDI)来评估预测性能。结果:在22,938名参与者中,在中位随访7.83年期间,观察到2,344例全因死亡(7.29%)和720例心血管死亡(2.12%)。多变量分析显示,失业(HR = 1.44, 95% CI: 1.25-1.66)、低收入状况(贫困收入比(PIR))是导致全因死亡率增加的独立预测因素。结论:失业、低PIR、严重的粮食不安全、未婚或独居是导致全因死亡率增加的独立预测因素。低PIR、未婚或独居也与心血管疾病死亡率相关。将这些sdoh纳入LE8框架可提高对两种死亡率结果的预测性能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Health, Population, and Nutrition
Journal of Health, Population, and Nutrition 医学-公共卫生、环境卫生与职业卫生
CiteScore
2.20
自引率
0.00%
发文量
49
审稿时长
6 months
期刊介绍: Journal of Health, Population and Nutrition brings together research on all aspects of issues related to population, nutrition and health. The journal publishes articles across a broad range of topics including global health, maternal and child health, nutrition, common illnesses and determinants of population health.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信