Association between social determinants of health and asthma in US: a cross-sectional study from NHANES 2001-2012

Social Determinants of Health (SDoH), encompassing economic, educational, medical, and environmental factors, are closely linked to respiratory health, yet their relationship with asthma diagnosis remains incompletely understood. This study explores the relationship between individual and cumulative SDoH and asthma prevalence, while investigating racial disparities in the association between SDoH and asthma risk.
Data on individual and cumulative SDoH and asthma diagnosis were obtained from self-reported survey questionnaires. Multivariable weighted logistic regression models were used to examine the relationship between individual and cumulative SDoH and asthma. Stratified analyses by sex and race/ethnicity were conducted, with additional adjustments for survey period, diabetes, hypertension, coronary heart disease, and total energy intake performed for sensitivity analyses.
The study included 26,224 adults with a weighted mean age of 46.69 years. Employment status, poverty-to-income ratio, food security, regular health-care access, and marital status were found to be closely associated with asthma diagnosis. The risk of asthma increased with the accumulation of adverse SDoH, consistent with sensitivity analysis results. Compared to those with zero unfavorable SDoH, individuals with 6 or more adverse indicators had a significantly higher risk (AOR = 5.93, 95% CI: 3.11–11.31). As the cumulative number of adverse SDoH increases, there is a significant trend of heightened asthma prevalence among non-Hispanic black, non-Hispanic white, and other racial groups, whereas Hispanic Americans do not exhibit this trend.
Our research indicates that both individual and cumulative exposure to adverse SDoH are associated with asthma incidence and may contribute to racial disparities in the American population. To address asthma discrepancies and promote health equity, future primary prevention strategies must integrate interventions targeting social determinants of health.