Differential Effects of Social Determinants of Health Factors on Mortality in US Adults with Prediabetes: National Health and Nutrition Examination Survey 2005–2018

Objective: This study investigated the association between social determinants of health (SDOH) factors and mortality in a nationally representative sample of U.S. adults with prediabetes. Methods: Data from 9,971 adults with prediabetes, drawn from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 and linked to the National Death Index (NDI), were analyzed. Five domains of SDOH—economic stability, environment, education, healthcare, and social/community context—were evaluated as independent variables. Cox proportional hazards regression models were used to assess the relationship between SDOH factors and all-cause mortality, evaluating (1) individual SDOH, (2) combined SDOH, and (3) fully adjusted models that accounted for demographics, lifestyle factors, and comorbidities. Results: A sample of 9,971 individuals, representing 51,836,778 US adults with prediabetes based on NHANES weighting procedures were included in the study, with 46.8% aged 20–54, 40.6% aged 55–74, and 12.6% aged 75 or older. Females comprised 53.7%. Racial/ethnic composition included 62.7% non-Hispanic White, 14.6% non-Hispanic Black, and 22.7% from other racial/ethnic groups. In the fully adjusted model, economic instability (HR = 1.38; 95% CI: 1.07 to 1.78; p = 0.012), limited education (HR = 1.25; 95% CI: 1.04 to 1.52; p = 0.020), and social/community context (HR = 1.36; 95% CI: 1.10 to 1.69; p = 0.006) were significantly associated with increased mortality risk. Conclusions: Economic instability, limited education, and social/community context were significantly associated with higher mortality among individuals with prediabetes. Addressing these SDOH factors are necessary for equitable diabetes prevention and improved public health outcomes.