Social determinants of health and biological age among diverse U.S. Adults, NHANES 2011–2018

Social determinants of health are fundamental drivers of health inequities. Education and income are inversely associated with accelerated aging, but less is known about differences in their association with aging by race/ethnicity. We examined the sex-specific association between each social determinant of health with biological age and by race/ethnicity. Data were sourced from four two-year National Health and Nutrition Examination Survey cycles (2011–2018). Education and household income were self-reported. The Klemera-Doubal Method, an algorithm using biomarkers from different organ systems, was used to calculate biological age among 6,213 females and 5,938 males aged 30–75 years who were Mexican, other Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or other/multi-racial. We used multivariable linear regression models to determine the association between education and income and biological age. Compared with a college education, less than a high school education was associated with higher biological age by 3.17 years (95% CI: 1.69, 4.65) among females only; associations were strongest among non-Hispanic Black, other Hispanic, and non-Hispanic Asian female adults. Compared with an annual income of ≥$75,000, an income <$25,000 was associated with higher biological age by 4.94 years (95% CI: 3.40, 6.47) among males and 2.74 years among females (95% CI: 1.48, 4.00); associations were strongest among non-Hispanic White and non-Hispanic Asian adults, and Mexican and other Hispanic males. These findings demonstrate that adverse levels of education and income are associated with greater biological age among females and males, and racial/ethnic minority adults in particular. Targeting upstream sources of social disadvantage among racial/ethnic minority groups, in conjunction with improvements to income and education, may promote healthy aging in these populations.