Social Determinants of Self-Reported Health in Vulnerable Populations During a Polycrisis in Lebanon.

Abstract

Importance: In the context of a polycrisis, which is characterized by multiple interconnected and mutually reinforcing crises, humanitarian and health needs increase. It is therefore crucial to identify social determinants impacting health and well-being of vulnerable populations to better inform appropriate interventions.

Objective: To assess the association between social determinants and pain frequency, self-rated health, and depression over time among vulnerable populations during a polycrisis in Lebanon.

Design, setting, and participants: In this population-based longitudinal cohort study, data were collected in Sin-El-Fil, a suburb of Beirut, Lebanon, in 4 waves: June 28 to October 26, 2022; September 8 to December 22, 2022; January 24 to April 28, 2023; and April 8 to July 5, 2024. Data for this analysis were extracted from a parent study around populations at high risk of COVID-19 infections, morbidity, and mortality and included a sample of Syrian refugees and migrants, pregnant women, older adults, and people of low socioeconomic status. Participants were selected via a multistage stratified sampling design. For this substudy, only individuals residing in neighborhoods with socioeconomic deprivation were considered.

Exposures: Food insecurity, nationality, wealth, educational level, and sex.

Main outcomes and measures: The outcomes were pain frequency (days per week), self-rated health (poor or fair, good, or very good or excellent), and depression (measured using the Patient Health Questionnaire-9). Survey-weighted generalized linear regression models were fitted for each outcome-exposure pair, and odds ratios (ORs) and 95% CIs were computed to report mean marginal estimates and time-specific estimates.

Results: The study included 1986 individuals at baseline (mean [SD] age, 44.7 [17.4] years); 1055 (53.1%) were female, 664 (33.4%) were Syrian refugees or migrants, 1025 (51.6%) had no high school degree, and 1451 (73.1%) had food insecurity. The exposure variables were significantly associated with elevated odds of reporting more pain, worse self-rated health, and more depression over time, with mean marginal ORs ranging from 1.03 (95% CI, 1.01-1.06) for worse self-rated health among women compared with men to 1.50 (95% CI, 1.46-1.55) for worse self-rated health among people with vs without food insecurity. The sole exception was for participant sex and depression, between which there was no association (OR, 0.99; 95% CI, 0.97-1.02).

Conclusions and relevance: In this cohort study, Syrian refugees and migrants, women, and individuals with food insecurity, lower wealth, and less education compared with other residents within the low socioeconomic status areas reported worse physical and mental health challenges, suggesting they carried an additional burden of disadvantage. The findings underscore a need for targeted interventions that focus on reducing health disparities within vulnerable communities, especially in contexts of polycrises.