J Diabetes Metab Disord. 2026 Oct 22;25(2):295. doi: 10.1007/s40200-026-02113-0. eCollection 2026 Dec.
ABSTRACT
OBJECTIVE: This study aims to examine the association between social determinants of health (SDOH) and all-cause mortality among middle-aged and elderly Chinese population across cardiovascular-kidney-metabolic (CKM) stages 0-4.
METHODS: This study included individuals across CKM stages 0-4 from the China Health and Retirement Longitudinal Study with baseline age ≥ 45 years. A cumulative SDOH score was constructed, and participants were stratified into four groups (normal group, low SDOH burden group, moderate SDOH burden group, and high SDOH burden group). Multivariate Cox regression, subgroup analyses and sensitivity analyses were used to examine the association between SDOH burden and all-cause mortality.
RESULTS: During a median follow-up of 9 years, 806 deaths (11.66%) were recorded. Multivariable Cox regression models revealed that each 1-point increase in the SDOH score was associated with a 20% elevated risk of all-cause mortality (HR = 1.20, 95% CI: 1.14-1.27, p < 0.001). Compared to the normal group, the moderate SDOH burden group (HR = 1.58, 95% CI: 1.19-2.10, p = 0.001) and high SDOH burden group (HR = 2.16, 95% CI: 1.65-2.82, p < 0.001) exhibited 58% and 116% increased mortality risks, respectively. Subgroup analysis demonstrated consistent associations between SDOH score and mortality across all subgroups (interaction p > 0.05). Sensitivity analyses using a weighted SDOH score yielded consistent results (HR = 1.21, 95% CI: 1.16-1.26, p < 0.001).
CONCLUSION: Higher SDOH burden is associated with higher all-cause mortality among population with CKM syndrome. This study underscores the necessity of incorporating SDOH screening into the CKM syndrome management framework.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02113-0.
PMID:42920673 | PMC:PMC13691030 | DOI:10.1007/s40200-026-02113-0