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

Background: Obesity is a well-established risk factor for cardiovascular disease and mortality, but its interplay with social determinants of health (SDoH) remains inadequately studied. Socioeconomic disadvantage can exacerbate health disparities, yet the cumulative impact of SDoH on premature mortality in individuals with obesity is not well understood. Objectives: SDoH are key contributors to cardiovascular disease, yet their cumulative impact on premature mortality among individuals with obesity remains underexplored. Methods: This study analyzed data from participants from the United States aged 18 to 64 in the 2013-2018 National Health Interview Survey, linked to the National Death Index. A 38-item SDoH index was used to evaluate social disadvantage. Multivariable Cox regression and Kaplan-Meier analyses assessed premature mortality risk across different SDoH burdens and obesity classes. Premature mortality is defined as all-cause death prior to age 65. Results: Among 136,816 participants, those with obesity were more likely to be non-Hispanic Black and face low income, lower education, food insecurity, and lack of health insurance. Mortality rates increased with higher SDoH burden and obesity class, with the highest rates observed in those with both severe SDoH and class 3 obesity. Specifically, individuals with high SDoH burden (Q3/Q4) and class 3 obesity had a 3.5-fold increased risk of premature mortality (HR: 3.53; 95% CI: 2.81-4.45) compared to those with favorable SDoH profiles and no obesity. Conclusions: Addressing both social and clinical risk factors is essential for reducing premature mortality among individuals facing the combined challenges of social disadvantage and obesity.