Presentation (CTI)

OBJECTIVES: Social Determinants Of Health (SDOH) are known drivers of health disparities. However, their role in influencing the timing of premature mortality, distinct from cause-of-death (COD) attribution, remains insufficiently characterized in large-scale mortality data. This study evaluates the association between SDOH burden and age at death and the value of SDOH-based risk stratification for early prioritization.
METHODS: We analyzed a national, de-identified mortality dataset of approximately one million individuals, linking person-level SDOH risk scores with age at death and COD. Individuals were ranked by SDOH risk using multivariable stratification. Premature mortality was defined as death before age 75 and quantified as years of life lost (YLL). Regression-based analyses were used to assess differences in YLL across SDOH risk strata and COD cohorts. Model performance was evaluated based on the concentration of YLL among higher SDOH risk rankings relative to uniform prioritization. Mean age-at-death differences between SDOH burden groups were estimated across COD categories, with uncertainty summarized using confidence intervals.
RESULTS: The SDOH-based risk ranking identified individuals with higher YLL. Individuals ranked at the highest SDOH risk accounted for approximately 2.7 times more premature mortality than expected under uniform prioritization. Higher SDOH burden was associated with earlier ages at death across multiple COD categories, with mean age-at-death differences between high- and low-SDOH burden groups ranging from 10 to 20 years for leading causes.
CONCLUSIONS: Large-scale analyses indicate that SDOH burden is associated with higher YLL and is reflected in the timing of premature mortality rather than recorded COD alone. An SDOH-based risk ranking identifies individuals at elevated risk of YLL and provides value for early prioritization. Integrating person-level SDOH risk data with mortality and cause-of-death information enables precise characterization of premature mortality patterns and informs population health management and prevention-focused investment.