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Cohort study examining social determinants of health and their association with mortality among hospitalised adults in New York and California
Open accessAbstract
Background: Adults in the US face significant disparities in health as a result of the social determinants of health (SDOH). While the link between SDOH and mortality is well-established, their impact on outcomes after hospitalisation is less understood. Methods: Among adults aged 18-84 years hospitalised in New York (NY) during the period of 2000-2009 and in California (CA) from during the period of 2000-2006, we examined the association between 1-year post-hospitalisation mortality and a community-level SDOH combined index (comprising six component domains) using Kaplan-Meier survival analysis and multivariable Cox proportional-hazard models to estimate the mortality HR (adjusted HR (aHR)) adjusted for age, gender, race, ethnicity and Charlson Comorbidity Index. We also studied subcohorts in NY and CA grouped by hospitalisation conditions (subgroups with chronic or acute disease). Results: In NY, the overall 1-year mortality rate was 8.9% (9.7% for chronic diseases and 13.2% for acute diseases). In CA, the overall 1-year mortality rate was 8.3% (12.6% for chronic diseases and 15.8% for acute diseases). In both states, the 1-year risk of death was significantly lower for those in the best (Q4) SDOH (combined index) compared with the worst (Q1 is the reference category). In NY, the aHR was 0.964 (p<0.001 and 95% CI 0.950 to 0.978), while in CA, the aHR: 0.83 (p<0.001 and 95% CI 0.825 to 0.842). Similar patterns were observed for the disease cohorts in both states. The Economic and Education domains of SDOH showed stronger and more consistent associations with mortality risk compared with the domains of Neighbourhood, Food Access, Community and Social Context, and Healthcare. Conclusions: This study demonstrates a significant association between worse SDOH and higher post-hospitalisation mortality. The findings emphasise the importance of community-level SDOH in patient care planning and discharge strategies to reduce health disparities.
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A 2025 retrospective cohort study of millions of hospitalized adults in New York and California found that patients from communities with weaker SDOH profiles experienced significantly higher one-year post-discharge mortality rates compared to those with stronger SDOH profiles, after adjusting for demographic and clinical risk factors.
“For example, a 2025 retrospective cohort study examined millions of hospitalized adults in New York and California, using a community-level SDOH index encompassing SES, education, neighborhood factors, food access, social context, and healthcare. After adjusting for demographic and clinical risk factors, the study found that patients from communities with weaker SDOH profiles experienced”
From Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health (2025) · cites this paper as [26]
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“21 22 By undertaking this investigation, we seek to contribute our understanding of how SDOH influences health outcomes in hospitalised patients and inform policymakers about the importance of SDOH to reduce health disparities within the healthcare system.”
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Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health
Wallington, S. F., & Feger, C. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22101541 · Cited by 6
Metadata
- Authors
- Wang, A., French, D., Black, B., & Kho, A. N.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Wang, Andrew
- Venue
- BMJ Public Health
- Publisher
- BMJ
- Published
- 2025-01
- Volume
- 3
- Issue
- 1
- Pages
- e001266
- ISSN
- 2753-4294 (ISSN-L)
- PMC
- PMC11934384
- OpenAlex
- W4408728065
- Cited by
- 1
- References
- 4
- Citations by year
- 2025: 1
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- BMJ Public Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Agency for Healthcare Research and Quality (HS000078/HS000084)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- social determinants of health, health disparities, hospitalized adults, chronic disease, acute illness, economic status, neighborhood, food access, social environment, health care access, discharge planning, New York, California
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