Associations of social determinants of health with premature mortality in different BMI–metabolic phenotypes: NHANES 1999–2018

Background: ody mass index (BMI)-metabolic phenotypes have an impact on premature mortality in the American population. We explored the effect of social determinants of health (SDoH) on premature mortality in different BMI–metabolic phenotypes. Methods: Using 41 075 American adults’ data from NHANES 1999–2018 after multiple imputation, participants were classified into six BMI–metabolic phenotypes. We assessed the impact of eight SDoH indicators (employment status, family income-to-poverty ratio, food security, educational attainment, health care access, health insurance status, home ownership, and marital or cohabitation status) and their cumulative effects on premature mortality, and explored their mediating roles in varied BMI–metabolic phenotypes. Results: Accumulation of adverse SDoH was associated with higher premature mortality risk; those with ≥6 adverse SDoH had a 5.02-fold increased risk. Metabolically, unhealthy individuals had a higher premature mortality risk than the metabolically healthy ones, and metabolic status had a greater impact than BMI. SDoH partially mediated the association between metabolic health and mortality but not between BMI and mortality. Conclusion: Accumulation of adverse SDoH significantly increases premature mortality risk. SDoH such as employment status, income, and education play important roles in explaining mortality risk among different metabolic phenotypes.