Observational studyJournal of general internal medicine2025
Social Determinants of Health and Cumulative Incidence of Mortality Among US Adults Without Major Chronic Diseases.
Observational study in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Living Alone as a Persistent Risk Factor for Smoking and High-Risk Drinking: A Three-Year Repeated Cross-Sectional Analysis Before and During the COVID-19 Pandemic in the Republic of Korea.Healthcare (Basel, Switzerland) · 2026Article
- Article
- Effects of the type and quality of usual source of care on medical expenditures in adults with diabetes before and during the COVID‑19 pandemic: a panel data analysis using the Korea Health Panel (2019-2022).BMC health services research · 2025Article
- Associations between dietary microbe intake and mortality risk in individuals with sleep disorders: Evidence from NHANES.PloS one · 2025Article
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
backgroundSocial determinants of health (SDOH) are associated with poor health outcomes among individuals with prevalent diseases.
objectiveTo quantify the association between adverse SDOH and mortality among adults without major chronic diseases in the United States (US).
designProspective observational study.
participantsWe used data from the National Health and Nutrition Examination Survey data (1999-2018). We included 11,413 adults without hypertension, diabetes, hyperlipidemia, severe obesity, chronic kidney disease, cardiovascular disease, chronic respiratory disease, cancer, liver disease, arthritis, hepatitis B or C, human immunodeficiency virus, or pregnancy. MAIN MEASURES: We calculated 15-year adjusted cumulative incidences of all-cause mortality by baseline SDOH and described the trends in the prevalence of adverse SDOH. KEY
resultsThe mean ±SD age was 34.9±11.2 years and 64.5% were non-Hispanic White. Over a median follow-up of 10.3 years, 275 participants died. The 15-year adjusted cumulative incidences of all-cause mortality were 5.6% (95%CI, 2.8-8.5), 5.2% (95%CI, 3.2-7.3), 4.9% (95%CI, 2.7-7.2), and 4.0% (95%CI, 2.8-5.2) for participants who had < 100% of the federal poverty level, were below high school education, had food insecurity, and were born in the US, respectively. A 1-point increase in cumulative SDOH score was associated with 33% increased risk of all-cause mortality [HR 1.33, 95%CI 1.16-1.52]. Neither health insurance [HR 0.97, 95%CI 0.60-1.55] nor access to a usual source of care [HR 1.23, 95%CI 0.76-1.99] was associated with mortality.
conclusionsIn this study of community-dwelling US adults without major chronic diseases, social risks were more strongly associated with mortality than healthcare access. Our findings challenge the conventional healthcare-centric approach to preventative care, emphasizing the need for proactive public health interventions targeting SDOH.
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