Cumulative Social Disadvantage and Health-Related Quality of Life: National Health Interview Survey 2013-2017

ABSTRACT Background Evidence of 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 We used data of respondents from the 2013-2017 National Health Interview Survey. A cumulative SDoH index was created by aggregating 46 SDoH from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). A higher SDoH index or quartile indicates greater disadvantage. Two outcomes were assessed: HALex score using two-part models, and a binary “poor HALex” (HALex score < 0.79 [20 th percentile]) using logistic regression. Regression analyses adjusted for demographics and comorbidities and were performed in the overall sample, and by age, sex, and race/ethnicity categories. Results Among 156,182 adults (mean age 46 years; 51.7% women), higher SDoH quartile groups averaged lower HALex scores and had higher proportions with poor HALex. A unit increase in SDoH index was associated with 0.01 decrease in HALex score (β = −0.01; 95% CI [−0.01, −0.01]) and 14% higher odds of poor HALex (odds ratio, OR = 1.14; 95% CI [1.14, 1.15]). Relative to SDoH-Q1, SDoH-Q4 was associated with HALex score decrease of −0.13 (95% CI [−0.13, −0.13]) and OR 8.67 (95% CI [8.08, 9.30]) for poor HALex. Hispanic persons, despite a relatively higher burden of cumulative social disadvantage, had a weaker SDoH-HALex association than their counterparts. Conclusion Higher cumulative social disadvantage was independently associated with lower HRQoL in an incremental fashion. The more favorable HRQoL profile observed in the Hispanic could be related to a resilient concept of health derived from cultural values and acceptance, and this highlights the need for population “wellness” interventions to be responsive to such phenomenon.