Association of social determinants of health with polycystic ovary syndrome: evidence from a case-control study

Polycystic Ovary Syndrome (PCOS), recently renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS), is a common endocrine disorder among women of reproductive age. Social factors can cause or exacerbate PCOS. This study aimed to investigate the relationship between social determinants of health and PCOS. This case-control study included 83 women with PCOS, recruited from the gynecology clinic of the Gonabad referral hospital and private gynecology offices, and 88 healthy controls in 2025. Participants were selected through convenience sampling. Data were collected using a demographic and social determinants of health (SDH) checklist, the Health Literacy Questionnaire, the Multidimensional Scale of Perceived Social Support (MSPSS), and the Household Food Insecurity Access Scale (HFIAS). Statistical analyses were performed using R4.6.1 software, with a significance level set at p < 0.05. In 83 PCOS (27.33 ± 5.73 year) and 88 control (28.23 ± 8.69 year) women, the PCOS group had lower childhood economic status ( p = 0.001), more renters ( p = 0.032), fewer rooms ( p = 0.010), better green space ( p = 0.002), and safety ( p = 0.005). PCOS group had higher BMI ( p = 0.020), more smokers (41.0% vs. 11.4%, p < 0.001), and more family history of PCOS, diabetes, and hyperlipidemia (all p < 0.05). Health literacy was higher ( p < 0.05), HFIAS lower ( p < 0.001) in PCOS; MSPSS did not differ. Multivariate regression: smoking (OR = 5.62), lack of safety (OR = 12.31), family hyperlipidemia (OR = 3.66), no green space (OR = 12.80), family PCOS (OR = 6.89), and parity (OR = 1.76) were risk factors; moderate (OR = 0.20) and low (OR = 0.11) childhood economic status and married status (OR = 0.23) were protective. PCOS was associated with social, environmental, lifestyle, and familial factors. Smoking, lack of neighborhood safety, absence of green space, positive family history of PCOS and hyperlipidemia, and higher parity were independently associated with increased odds of PCOS. Married status and lower childhood economic status showed a protective association, highlighting the role of social and environmental determinants in PCOS.