@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 (&lt;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 (&gt;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}},
}