Unfavorable Social Determinants of Health and Obesity: A Double Jeopardy for Premature Mortality (JACC: Advances November 2025)-Article: Unfavorable Social Determinants of Health and Obesity: A Double Jeopardy for Premature Mortality

Article: Unfavorable Social Determinants of Health and Obesity: A Double Jeopardy for Premature Mortality

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This study, published in JACC Advances in 2025, investigates the combined impact of unfavorable social determinants of health (SDoH) and obesity on premature mortality among U.S. adults aged 18 to 64. Using data from the 2013-2018 National Health Interview Survey linked to the National Death Index, the researchers developed a 38-item cumulative SDoH index encompassing economic stability, neighborhood environment, social context, food insecurity, education, and healthcare access. Obesity was classified into four groups by BMI: nonobese, and class 1 to 3 obesity (BMI ≥30 kg/m², with increasing severity).<br /><br />Among 136,816 participants, those with obesity (33.4%) were more likely to experience adverse SDoH, such as lower income, food insecurity, unemployment, and lower education, compared to nonobese individuals. Higher obesity classes showed greater comorbidity burden, including diabetes, hypertension, and chronic diseases. The study found that both increased SDoH burden and obesity severity independently raised the risk of premature mortality (death before age 65). Importantly, individuals with high SDoH burden (top half of index) and class 3 obesity faced a 3.5-fold higher risk of premature death compared to those with low SDoH burden and no obesity.<br /><br />Kaplan-Meier survival analyses demonstrated that mortality risk escalates synergistically with both social disadvantage and obesity severity. This “double jeopardy” effect was consistent across sex and race/ethnicity groups, though somewhat stronger among non-Hispanic Black and male participants. The findings highlight that socioeconomic and environmental factors related to social disadvantage, such as food insecurity and limited healthcare access, intertwine with obesity to compound health risks.<br /><br />The study emphasizes the need for healthcare systems to integrate routine screening for SDoH and obesity into clinical practice, including documentation in electronic medical records. Developing polysocial risk scores can enhance risk stratification and inform targeted interventions. Addressing upstream social factors through community partnerships, policy reforms, and improving access to healthy foods and healthcare could reduce disparities in cardiovascular outcomes and premature mortality. Limitations include the cross-sectional design, self-reported data, and exclusion of some ethnic groups. Overall, this research underscores the critical interplay between social and clinical factors in driving mortality risk and the importance of comprehensive, equity-focused strategies to improve outcomes in populations facing obesity and social disadvantage.

Keywords

social determinants of health

obesity

premature mortality

U.S. adults

cumulative SDoH index

body mass index (BMI)

comorbidity burden

Kaplan-Meier survival analysis

health disparities

risk stratification