Cumulative Social Determinants of Health Are Associated With Anxiety: A Weighted Quantile Sum Analysis

Social determinants of health (SDoH) are key contributors to mental health disparities; however, the cumulative impact of multiple SDoH and the relative contribution of individual domains to anxiety remain unclear. Data were drawn from 3 NHANES cycles (2007-2012), including 11 547 adults aged ≥20 years. Anxiety was defined based on self-reported days of feeling worried, tense, or anxious during the past 30 days (≥7 days vs 0-6 days). Eight SDoH indicators were categorized according to the 5 domains of Healthy People 2030. Survey-weighted logistic regression estimated the associations between each SDoH and anxiety after adjustment for demographic, behavioral, and health covariates. A Weighted Quantile Sum (WQS) regression was further applied to assess the cumulative effect and the relative contribution of each SDoH factor. In fully adjusted models, unemployment (OR = 1.44, 95% CI: 1.17-1.76, P = .001) and food insecurity showed strong dose-response associations with anxiety: Marginal food security (OR = 1.38, 95% CI: 1.08-1.75, P = .010), Low food security (OR = 1.66, 95% CI: 1.30-2.13, P < .001), and Very low food security (OR = 1.97, 95% CI: 1.55-2.51, P < .001). The WQS model revealed a significant cumulative burden of social risk factors of health on anxiety (OR = 1.56, 95% CI: 1.22-2.00, P < .001), with the highest weights for food insecurity (0.377), housing instability (0.201), and marital status (0.198). These associations were consistent across sex, age, and racial/ethnic subgroups. Cumulative social determinants of health were significantly associated with anxiety among U.S. adults. Food insecurity, housing instability, marital status, and poverty-to-income ratio were the primary contributors. These findings emphasize the importance of addressing multiple co-occurring social disadvantages in mental health prevention efforts.