Associations of social determinants of health with temporal sequence of cardiovascular-kidney-metabolic multimorbidity

Background The association of social determinants of health (SDOH) with the development of cardiovascular-kidney-metabolic (CKM) multimorbidity is unclear. Purpose Using multi-state models, we aim to investigate associations between SDOH and the risks of CKM transitions. Methods This prospective cohort study used data from participants free of CKM in the UK Biobank. CKM included cardiovascular disease, chronic kidney disease, and type 2 diabetes. We classified participants into three SDOH levels using tertiles of weighted numbers of disadvantaged SDOH: favourable, medium, and unfavourable. We used multi-state models to examine the associations of SDOH levels with the CKM progression. Results We included 348 224 participants, during a median follow-up of 13.6 years, 54 502 participants developed the first CKM, 7603 developed the second CKM, and 656 developed the third CKM. Compared with participants with favourable SDOH, participants with unfavourable SDOH were associated with transitions from baseline to first CKM (HR: 1.74, 95%CI: 1.71, 1.78), first CKM to second CKM (HR: 1.67, 95%CI: 1.57, 1.77), and second CKM to third CKM (HR: 1.52, 95%CI: 1.23, 1.87). The associations between SDOH and CKM multimorbidity transitions were heterogeneous across age, sex, and lifestyle subgroups that middle-aged participants, females, or participants with less healthy lifestyles had stronger associations of unfavourable SDOH with CKM progression. Conclusions Our study found that unfavourable SDOH was associated with a higher risk of CKM multimorbidity progression and highlighted that screening for SDOH is of great importance to prevent CKM onset and progression.