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

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• dc.contributor.author Hagan, Kobina
• dc.contributor.author Javed, Zulqarnain
• dc.contributor.author Cainzos-Achirica, Miguel
• dc.contributor.author Hyder, Adnan A.
• dc.contributor.author Mossialos, Elias
• dc.contributor.author Yahya, Tamer
• dc.contributor.author Acquah, Isaac
• dc.contributor.author Valero-Elizondo, Javier
• dc.contributor.author Pan, Alan
• dc.contributor.author Nwana, Nwabunie
• dc.contributor.author Taha, Mohamad B.
• dc.contributor.author Nasir, Khurram
• dc.date.accessioned 2025-05-05T06:17:36Z
• dc.date.available 2025-05-05T06:17:36Z
• dc.date.issued 2023
• dc.description.abstract 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.en
• dc.format.mimetype application/pdf
• dc.identifier.citation Hagan K, Javed Z, Cainzos-Achirica M, Hyder AA, Mossialos E, Yahya T, et al. Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017. BMC Public Health. 2023 Sep 4;23(1):1-13. DOI: 10.1186/s12889-023-16168-8
• dc.identifier.doi http://dx.doi.org/10.1186/s12889-023-16168-8
• dc.identifier.issn 1471-2458
• dc.identifier.uri http://hdl.handle.net/10230/70274
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof BMC Public Health. 2023 Sep 4;23(1):1-13
• dc.rights © [Author(s)]. Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Health-related quality of lifeen
• dc.subject.keyword Health and Activity Limitation Indexen
• dc.subject.keyword HALexen
• dc.subject.keyword Quality of lifeen
• dc.subject.keyword Social determinants of healthen
• dc.title Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017en
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion