Cohort-Level SDoH, Mortality, and Life Expectancy in Rheumatoid Arthritis

An abstract links a composite social determinants of health (SDoH) score with mortality, life expectancy, and a range of future health risks among adults with rheumatoid arthritis across two large cohorts, the China Kadoorie Biobank and the UK Biobank.

The abstract summarizes associations across three outcome areas: all-cause mortality, estimated life expectancy at age 45, and phenome-wide incident conditions. Overall, an unfavorable SDoH profile tracked with multiple adverse outcomes in both settings.

Investigators analyzed 10,298 rheumatoid arthritis patients aged 30–79 years from the China Kadoorie Biobank and 4,975 patients aged 37–73 years from the UK Biobank. They report generating a composite SDoH score incorporating five domains—financial circumstances, education, healthcare access, neighborhood environment, and social context—and categorizing participants into favorable, medium, and unfavorable groups. Results are presented for the unfavorable SDoH category without explicitly specifying the comparison group for each estimate. This sets up the SDoH construct and groupings used for the cross-cohort analyses.

For mortality, the abstract reports median follow-up of 10.4 years in China and 13.8 years in the UK, with adjusted associations described as unfavorable versus favorable SDoH. Higher mortality risk is reported in both cohorts, with China HR 1.62 (95% CI 1.36–1.92) and UK HR 1.80 (95% CI 1.50–2.16).

For life expectancy, the abstract reports estimated reductions at age 45 associated with unfavorable SDoH, with cohort- and sex-specific patterns. In China, reductions are reported as 4.7 years for women and 4.0 years for men, while in the UK they are reported as 6.8 years for men and 4.0 years for women. The abstract presents these differences as varying by sex within each cohort without detailing explanatory factors.

Beyond mortality and life expectancy, the abstract describes a phenome-wide incident disease analysis in which 51 incident conditions were identified with 1.2- to 5.2-fold increased risks among participants with unfavorable SDoH, with examples including heart failure, obstructive chronic bronchitis, and renal failure. The authors conclude that disadvantaged (unfavorable) SDoH were associated with lower life expectancy and higher risks of multiple adverse health outcomes among adults with rheumatoid arthritis.

Taken together, the abstract describes a pattern in which disadvantaged SDoH tracked with higher mortality, lower life expectancy, and elevated multimorbidity risk.

Key Takeaways:

• The abstract reports that unfavorable versus favorable composite SDoH was associated with higher mortality in both the China and UK cohorts.
• Life-expectancy reductions at age 45 were reported with cohort- and sex-specific patterns.
• The authors conclude that unfavorable SDoH was associated with higher risks across many incident conditions in their phenome-wide analysis.