Examining the Relationships between Social Determinants of Health and Health-Related Quality of Life Among Individuals Living with Multimorbidity

OBJECTIVES: Social determinants of health (SDOH) are crucial factors influencing health outcomes. Individuals living with multimorbidity, defined as the concurrent presence of two or more chronic conditions, often face unfavorable SDOH and experience complex social and health challenges that can impact their health-related quality of life (HRQOL). This study investigates the association between SDOH and HRQOL among individuals living with multimorbidity.

METHODS: For this cross-sectional study, we utilized the 2020 Medical Expenditure Panel Survey (MEPS) data for the U.S. civilian, non-institutionalized population. Our study included adult participants (age > 18 years) with multimorbidity (N = 6,839, weighted N = 97,871,117). We operationalized nine SDOH variables based on the Healthy People 2030 framework. These SDOH variables were also measured as a composite index or poly-risk score. HRQOL was assessed using the Short Form 12-item (version 2) Health Survey (SF-12v2) summary scores (PCS and MCS). Multivariable linear regressions were employed to evaluate the association between SDOH and HRQOL, with adjustments for age, sex, race, ethnicity, number of chronic conditions, and lifestyle factors.

RESULTS: Among adults with multimorbidity, the mean PCS and MCS scores were 44.5 and 50.01, respectively. The SDOH score ranged from 0 to 9. Our findings revealed a positive association between the SDOH score and lower HRQOL outcomes in both the physical and mental domains. Specifically, individuals with any SDOH score above 0 had significantly lower PCS and MCS scores compared to those with no SDOH.

CONCLUSIONS: Our study provides compelling evidence of the association between SDOH and HRQOL among individuals living with multimorbidity. To enhance the health and well-being of this vulnerable population, it is imperative to integrate efforts to address SDOH into multimorbidity care plans. Future research should explore effective interventions aimed at addressing SDOH and improving HRQOL outcomes in this population.