Joint and mediating effects of cardiovascular health in the association between social determinants of health and mortality among postmenopausal women : Evidence from a nationally representative cohort study
(2026) In Maturitas 209.- Abstract
Objectives: To examine the joint effects and mediating role of cardiovascular health (CVH) in the association between social determinants of health and mortality among postmenopausal women. Study design: A nationally representative cohort of 7577 postmenopausal women from NHANES 2003–2018, with mortality follow-up through 2019. Main outcome measures: Social determinants of health were derived from eight indicators across five Healthy People 2030 domains, and CVH was assessed using the Life's Essential 8 score. Survey-weighted Cox models estimated hazard ratios (HRs), with risk advancement periods (RAPs) quantifying time shifts. Joint associations were examined by combining social determinants of health (<3 vs. ≥3) and CVH (high,... (More)
Objectives: To examine the joint effects and mediating role of cardiovascular health (CVH) in the association between social determinants of health and mortality among postmenopausal women. Study design: A nationally representative cohort of 7577 postmenopausal women from NHANES 2003–2018, with mortality follow-up through 2019. Main outcome measures: Social determinants of health were derived from eight indicators across five Healthy People 2030 domains, and CVH was assessed using the Life's Essential 8 score. Survey-weighted Cox models estimated hazard ratios (HRs), with risk advancement periods (RAPs) quantifying time shifts. Joint associations were examined by combining social determinants of health (<3 vs. ≥3) and CVH (high, moderate, low). Counterfactual mediation analyses quantified the mediating role of CVH. Results: Over a median 79-month follow-up, 1247 deaths occurred. Each unfavorable social determinant of health significantly increased all-cause, CVD, and cancer mortality by 23%, 24%, and 23% (RAPs +2.2, +1.6, +2.7 years), respectively. Each 10-point decrease in CVH score significantly increased mortality by 28%, 36%, and 26% (RAPs +2.6, +2.3, +3.1 years). Women with both high social determinants of health burden (>3) and low CVH had the highest all-cause, CVD, and cancer mortality (HRs = 4.14, 5.01, 5.61), corresponding to RAPs of 15.6, 12.5, and 23.4 years. CVH explained 20.4%, 27.7%, and 19.6% of the associations between cumulative unfavorable social determinants of health and all-cause, CVD, and cancer mortality, respectively. Conclusions: Cumulative unfavorable social determinants of health and poor CVH jointly contribute to higher and earlier mortality in postmenopausal women. Enhancing CVH can attenuate the mortality disparities driven by social disadvantage.
(Less)
- author
- Guo, Huijie ; Ye, Yilu ; Ji, Jianguang and Wang, Xiao LU
- organization
- publishing date
- 2026-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiovascular health, Life's essential 8, NHANES, Postmenopausal women, Social determinants of health
- in
- Maturitas
- volume
- 209
- article number
- 108932
- publisher
- Elsevier
- external identifiers
-
- pmid:41950770
- scopus:105035097002
- ISSN
- 0378-5122
- DOI
- 10.1016/j.maturitas.2026.108932
- language
- English
- LU publication?
- yes
- id
- ff23afc7-c3d0-4cd5-8904-d28f8b563a8b
- date added to LUP
- 2026-06-12 08:34:40
- date last changed
- 2026-06-26 09:17:30
@article{ff23afc7-c3d0-4cd5-8904-d28f8b563a8b,
abstract = {{<p>Objectives: To examine the joint effects and mediating role of cardiovascular health (CVH) in the association between social determinants of health and mortality among postmenopausal women. Study design: A nationally representative cohort of 7577 postmenopausal women from NHANES 2003–2018, with mortality follow-up through 2019. Main outcome measures: Social determinants of health were derived from eight indicators across five Healthy People 2030 domains, and CVH was assessed using the Life's Essential 8 score. Survey-weighted Cox models estimated hazard ratios (HRs), with risk advancement periods (RAPs) quantifying time shifts. Joint associations were examined by combining social determinants of health (<3 vs. ≥3) and CVH (high, moderate, low). Counterfactual mediation analyses quantified the mediating role of CVH. Results: Over a median 79-month follow-up, 1247 deaths occurred. Each unfavorable social determinant of health significantly increased all-cause, CVD, and cancer mortality by 23%, 24%, and 23% (RAPs +2.2, +1.6, +2.7 years), respectively. Each 10-point decrease in CVH score significantly increased mortality by 28%, 36%, and 26% (RAPs +2.6, +2.3, +3.1 years). Women with both high social determinants of health burden (>3) and low CVH had the highest all-cause, CVD, and cancer mortality (HRs = 4.14, 5.01, 5.61), corresponding to RAPs of 15.6, 12.5, and 23.4 years. CVH explained 20.4%, 27.7%, and 19.6% of the associations between cumulative unfavorable social determinants of health and all-cause, CVD, and cancer mortality, respectively. Conclusions: Cumulative unfavorable social determinants of health and poor CVH jointly contribute to higher and earlier mortality in postmenopausal women. Enhancing CVH can attenuate the mortality disparities driven by social disadvantage.</p>}},
author = {{Guo, Huijie and Ye, Yilu and Ji, Jianguang and Wang, Xiao}},
issn = {{0378-5122}},
keywords = {{Cardiovascular health; Life's essential 8; NHANES; Postmenopausal women; Social determinants of health}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Maturitas}},
title = {{Joint and mediating effects of cardiovascular health in the association between social determinants of health and mortality among postmenopausal women : Evidence from a nationally representative cohort study}},
url = {{http://dx.doi.org/10.1016/j.maturitas.2026.108932}},
doi = {{10.1016/j.maturitas.2026.108932}},
volume = {{209}},
year = {{2026}},
}