Associations of Social Determinants of Health and All‐Cause and Cause‐Specific Mortality: UK Biobank Cohort Study

AIM: Social determinants of health (SDHs) play an important role in addressing inequitable and avoidable disparities in health status within countries but lack systematic assessment in broad populations. The aim of this study was to determine the association of SDHs, individually, in combination and cumulatively, with all-cause mortality risk, cardiovascular disease (CVD) mortality, and cancer mortality. METHODS: Data were obtained from 190,239 adults in the UK Biobank. Exposure variables were SDHs assessed by self-reported sociodemographic characteristics using standardized questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models to estimate the associations of combined SDHs and cumulative number of SDHs with all-cause, CVD, and cancer mortality. RESULTS: Over a median 12-year follow-up, 9,871 deaths occurred, including 1,673 from CVD and 5,199 from cancer. Compared to favorable SDHs, medium SDHs (HR 1.143; 95% CI 1.090-1.198) and unfavorable SDHs (HR 1.642; 95% CI 1.559-1.729) were associated with higher all-cause mortality risks. Medium and unfavorable SDHs were associated with increased risks of CVD mortality (by 16.3% and 81.5%) and cancer mortality (by 7.7% and 26.1%). Having ≥8 cumulative adverse SDHs significantly heightened all-cause mortality risk. In exploratory analyses, baseline hypertension and diabetes statistically accounted for a portion of the associations between combined SDHs and mortality outcomes. CONCLUSIONS: Unfavorable SDHs are substantially associated with increased risks of all-cause, CVD, and cancer mortality. Exploratory findings suggest that baseline hypertension and diabetes substantially explain these associations, highlighting existing disease burden as a key driver of health inequalities.