ArticleAnnals of medicine2025
Social determinants of health and age-related differences in all-cause mortality: evidence from National Health and Nutrition Examination Survey.
Article in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundUnfavorable social determinants of health (SDoH) are linked to higher risks of poor health, but evidence on their age-specific distribution and association with all-cause mortality are limited.
methodsWe analyzed NHANES data (2003-2018) from 14,604 participants, stratified by age and cumulative unfavorable SDoH. The association between SDoH and all-cause mortality was assessed using Kaplan-Meier curves, Cox regression models, and restricted cubic spline (RCS) analysis.
resultsAmong 14,604 participants, 1,835 deaths (8.78%) were recorded. Kaplan-Meier curve analysis showed lower survival rates in the middle and high SDoH groups compared to the low SDoH group. RCS analysis showed a nonlinear relationship between SDoH and all-cause mortality. Cox regression analysis revealed that higher SDoH scores were significantly associated with increased all-cause mortality across all age groups. After full adjustment, each unit increase in SDoH score was linked to a 21% higher mortality risk in young group, 28% in middle-aged group, and 13% in the elderly. Compared to those with low SDoH, individuals in the high SDoH group had the greatest mortality risk in the middle-aged group (HR: 3.10). Distinct SDoH patterns emerged across ages: employment status, food security, and health insurance status were key in young group; middle-aged group were affected by a broader range of SDoH components, while the elderly showed weaker but still significant associations.
conclusionSDoH characteristics differ across age groups, and unfavorable SDoH are strongly associated with higher all-cause mortality, with age-specific variations. Targeted interventions are needed to address each age group's unique health needs.
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